Publications by authors named "Rinaldo Bellomo"
Background: Hypernatremia is relatively common in acutely ill patients and associated with mortality. Guidelines recommend a slow rate of correction (≤ 0.5 mmol/L per hour).
View Article and Find Full Text PDFBackground: The impact of noninvasive ventilation (NIV) managed outside the intensive care unit in patients with early acute respiratory failure remains unclear. We aimed to determine whether adding early NIV prevents the progression to severe respiratory failure.
Methods: In this multinational, randomised, open-label controlled trial, adults with mild acute respiratory failure (arterial oxygen partial pressure/fraction of inspiratory oxygen [Pao/FiO] ratio ≥200) were enrolled across 11 hospitals in Italy, Greece, and Kazakhstan.
Article Synopsis
- Acute kidney injury (AKI) is a common and serious problem following out-of-hospital cardiac arrest (OHCA), particularly influenced by post-resuscitation cardiogenic shock (CS).
- A study compared two groups of patients—those receiving targeted mild hypercapnia and those receiving targeted normocapnia—to see if higher carbon dioxide tension impacted AKI rates and other outcomes.
- Results showed that approximately 72.1% of patients developed AKI regardless of treatment, with CS significantly increasing the likelihood of AKI, but carbon dioxide levels did not alter this relationship.
Background: Excessive exposure to adrenergic vasopressors may be harmful. Non-adrenergic vasopressors may spare adrenergic agents and potentially improve outcomes. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of non-adrenergic vasopressors in adult patients receiving vasopressor therapy for vasodilatory shock or perioperative vasoplegia.
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- This study investigates the effects of vitamin C and hydrocortisone on pediatric sepsis, aiming to improve survival rates without the need for inotropes/vasopressors.
- The RESPOND trial is a randomized, open-label study involving nine PICUs in Australia and New Zealand, focusing on children under 18 with suspected or confirmed sepsis.
- It will assess outcomes such as time alive without inotropic support, mortality rates, and quality of life, involving 384 patients to generate robust data for better treatment strategies.
Objective: To develop age-appropriate nonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) risk tool for classifying patients who may or may not develop postoperative complications or die within their index hospital admission.
Background: There are no validated perioperative risk stratification tools for use in nonagenarian and centenarian patients-people aged 90 to 99 years and >100 years.
Methods: In this retrospective observational study, nonagenarians and centenarians undergoing any surgical procedure were profiled.
Background: In the PROTECTION trial, intravenous amino acids (AA) decreased the occurrence of acute kidney injury (AKI) in cardiac surgery patients with cardiopulmonary bypass (CPB). Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease (CKD) have diminished renal functional reserve, and AA may be less protective in such patients.
View Article and Find Full Text PDFPurpose: Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.
Materials And Methods: We performed a two-center, pilot, open-label, randomized trial.
Purpose: Patients with Cardiogenic shock (CS) admitted to intensive care units (ICUs) have high mortality rates. We aimed to investigate the changes patient characteristics and outcomes over time among patients admitted to the ICU with CS.
Methods: Retrospective study utilizing a large bi-national ICU database from 2003 to 2022.
Objective: The combination of catecholamine-resistant vasodilatory shock and acute kidney injury (AKI) is associated with high morbidity and mortality. The role of angiotensin II (ANGII) in this setting is unclear. Methods: We conducted a post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS) 3 trial which assessed the effect of Intravenous ANG II or placebo in patients with refractory vasodilatory shock in 75 intensive care units across nine countries in North America, Australasia, and Europe.
View Article and Find Full Text PDFBackground: The timely identification and transfer of critically ill patients from the emergency department (ED) to the intensive care unit (ICU) is important for patient care and ED workflow practices.
Objective: We aimed to develop a predictive model for ICU admission early in the course of an ED presentation.
Methods: We extracted retrospective data from the electronic medical record and applied natural language processing and machine learning to information available early in the course of an ED presentation to develop a predictive model for ICU admission.
Background: Acute kidney injury (AKI) is a frequent and important complication of cardiac surgery. Decreased perfusion is a key mechanism. This decreased perfusion may be attenuated by intravenous amino acids (AAs) through recruitment of renal functional reserve.
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- The study aimed to evaluate the connection between angiotensin-II treatment and thromboembolic events in adult patients undergoing shock treatment.
- After screening 1689 records, seven studies involving 1461 patients were included, revealing a significant risk of bias among the studies but overall similar rates of thromboembolic events between the angiotensin-II group and controls.
- The findings concluded that there is insufficient evidence to establish a definitive link between angiotensin-II and an increased risk of thromboembolic events.
Background: Chronic kidney disease (CKD) is a common complication after acute kidney injury (AKI). We aimed to evaluate whether RRT initiation strategy had an effect on CKD progression. Secondarily, we aimed to identify factors that influenced the development or progression of CKD following severe AKI.
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- Acute kidney injury (AKI) often occurs in patients with vasodilatory shock and is linked to higher mortality rates, longer hospital stays, and potential chronic kidney disease.
- A comparison of catecholamine vasopressors (like norepinephrine and epinephrine) with non-catecholamine options (like vasopressin and angiotensin II) indicated that catecholamines could worsen kidney function and recovery.
- Research showed that non-catecholamine vasopressors were associated with better renal outcomes, including lower serum creatinine levels and reduced need for kidney replacement therapy.
Background: The safety and efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in hospitalized patients are unclear.
Purpose: To evaluate outcomes of inpatient SGLT2 inhibitor use.
Data Sources: MEDLINE, Embase, Emcare, and Cochrane databases were searched through 29 May 2024.
Dysregulation of the renin-angiotensin-aldosterone-system (RAAS) in sepsis is a complex and early phenomenon with a likely significant contribution to organ failure and patient outcomes. A better understanding of the pathophysiology and intricacies of the RAAS in septic shock has led to the use of exogenous angiotensin II as a new therapeutic agent. In this review, we report a multinational and multi-disciplinary expert panel discussion on the role and implications of RAAS modulation in sepsis and the use of exogenous angiotensin II.
View Article and Find Full Text PDFIntroduction: Paracetamol (acetaminophen)-induced acute liver failure (ALF) with severe hyperammonemia (ammonia >100 µmol⋅L-1) is a life-threatening condition. A strategy based on high-intensity continuous renal replacement therapy (CRRT) without early (up to day seven) transplantation may enable clinicians to safely identify which patients can recover and survive and which patients require transplantation.
Methods: We conducted a single-center, retrospective cohort study of patients with severely hyperammonemic paracetamol-induced ALF.
Background: Fluid therapy is universally administered in the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin results in both lower fluid volumes and early cumulative fluid balance, and may reduce short-term mortality in patients with septic shock.
Methods: In this single centre, open label, feasibility trial; patients with early septic shock will be randomly allocated either 20% albumin for resuscitation and daily supplementation, versus buffered crystalloids alone for all fluid therapy.
Article Synopsis
- Neuroimaging using MRI can help assess brain injuries in comatose adults after cardiac arrest, but data on its use is limited.
- In a study involving 1,639 patients from the TAME trial, only 9% underwent MRI, showing key differences in age, time to resuscitation, and lactate levels compared to those who did not.
- Six months later, only 16% of MRI patients had a favorable neurological outcome, highlighting concerns about the effectiveness of MRI in this context.
Introduction: Hemoadsorption can be used as adjunctive therapy for sepsis. However, there is limited evidence regarding its antibiotic removal. In this in vivo preclinical study, we aimed to evaluate the removal of meropenem and piperacillin with the HA380 hemoadsorption cartridge.
View Article and Find Full Text PDFObjectives: To assess whether angiotensin II infusion increases pulmonary vascular resistance (PVR) relative to norepinephrine.
Design: Secondary analysis of a double-blinded randomized feasibility study.
Setting: Two tertiary metropolitan hospitals in Melbourne, Australia.