Hemodynamic management of acute kidney injury.

Purpose Of Review: To discuss the role of hemodynamic management in critically ill patients with acute kidney injury.

Recent Findings: Acute kidney injury (AKI) may be associated with persistent alterations in renal perfusion, even when cardiac output and blood pressure are preserved. The effects of interventions aiming at increasing renal perfusion are best evaluated by renal Doppler or contrast enhance ultrasound.

Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock.

In this prospective, observational study, we measured arterial lactate and pyruvate concentrations within the first four hours of shock and at four hour intervals during the first 24 hours in 26 patients with septic and 13 with cardiogenic shock. We also studied 10 intensive care unit patients with normal lactate levels as controls. Seven patients (18%) died during the first 24 hours of shock, 12 (31%) patients died later in the intensive care unit and 21 (54%) were discharged alive from the intensive care unit.

Survival and quality of life after prolonged intensive care unit stay.

There are few data on long-term outcomes in mixed groups of intensive care unit (ICU) patients with prolonged stays. We evaluated the relationship between length of stay in the ICU and long-term outcome in all patients admitted to our 31-bed department of medico-surgical intensive care over a one-year period who stayed in the department for more than 10 days (n = 189, 7% of all ICU admissions). Mortality increased with length of stay from 1 to 10 days (1 day 5%, 5 days 15%, 9 days 24%, 10 days 33%) but remained stable at about 35% for longer ICU stays.