A Critical Reassessment of the Kidney Risk Caused by Tetrastarch Products in the Perioperative and Intensive Care Environments.

To reassess the results of former meta-analyses focusing on the relationship between novel HES preparations (130/0.4 and 130/0.42) and acute kidney injury.

Pneumoperitoneum and Acute Kidney Injury-An Integrative Clinical Concept Review.

An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion.

Mediators of Regional Kidney Perfusion during Surgical Pneumo-Peritoneum Creation and the Risk of Acute Kidney Injury-A Review of Basic Physiology.

Acute kidney injury (AKI), especially if recurring, represents a risk factor for future chronic kidney disease. In intensive care units, increased intra-abdominal pressure is well-recognized as a significant contributor to AKI. However, the importance of transiently increased intra-abdominal pressures procedures is less commonly appreciated during laparoscopic surgery, the use of which has rapidly increased over the last few decades.

Reinterpreting Renal Hemodynamics: The Importance of Venous Congestion and Effective Organ Perfusion in Acute Kidney Injury.

The significance of effective renal perfusion is relatively underemphasized in the current literature. From a renal standpoint, besides optimizing cardiac output, renal perfusion should be maximized as well. Among the several additional variables of the critically ill, such as intra-abdominal pressure, the presence of venous congestion and elevated central venous pressures, airway pressures generated by mechanical ventilation do affect net renal perfusion.

The value of combined hemodynamic, respiratory and intra-abdominal pressure monitoring in predicting acute kidney injury after major intraabdominal surgeries.

Background: The incidence of postoperative acute kidney injury (AKI) is predominantly determined by renal hemodynamics. Beside arterial blood pressure, the role of factors causing a deterioration of venous congestion (intraabdominal pressure, central venous pressure, mechanical ventilation) has emerged. The value of combined hemodynamic, respiratory and intra-abdominal pressure (IAP) monitoring in predicting postoperative acute kidney injury has received only limited exploration to date.

Renoprotective Postoperative Monitoring: What Is the Best Method for Computing Renal Perfusion Pressure? An Observational, Prospective, Multicentre Study.

Background: Low mean arterial pressure (MAP) is a well-known risk factor for postoperative acute kidney injury (AKI), but probably it is not the sole hemodynamic parameter that can influence the development of renal failure. There are data in cardiac patients supporting the role of renal venous congestion in the development of AKI. The aim of our study was to determine a combination of factors best predicting the development of AKI.

Estimation of the severity of breathlessness in the emergency department: a dyspnea score.

Background: Dyspnea is a frequent complaint in emergency departments (ED). It has a significant amount of subjective and affective components, therefore the dyspnea scores, based on the patients' rating, can be ambiguous. Our purpose was to develop and validate a simple scoring system to evaluate the severity of dyspnea in emergency care, based on objectively measured parameters.

[Prevalence and associated factors of sarcopenia among older adults living in institutions providing long-term care].

Introduction: Earlier studies dealing with sarcopenia were conducted among community-living or hospitalized older adults; however, to date, study focusing on older adults living in institutions providing long-term care is lacking.

Aim: The aim of this study was to describe the prevalence of sarcopenia and its associations with lifestyle and health factors among older people living in institutions providing long-term care.

Method: Two hundred five individuals participated in the study.

Detecting hypovolemia in postoperative patients using a discrete Fourier transform.

In the present paper, an attempt was made to find waveform-derived variables that would be useful for a more precise diagnosis of hypovolemia. In attempting this, arterial blood pressure graphs of 18 hypovolemic postoperative patients were analysed using a discrete Fourier transform. Using a paired samples t-test, the amplitude of the first harmonic (A1) is shown to be significantly higher in normovolemic cases than in hypovolemic ones (p < 0.

The effect of functional movement ability on the quality of life after total hip replacement.

Aims And Objectives: To analyse in detail the relationship between the movement and generic health-related quality of life (HRQoL) indicators and the subjective feeling of health of the patients, as well as the objective movement parameters measured by the surgeon and the patient's opinion about the success of the total hip replacement (THR).

Background: We have only limited information about the effect of mobility function improvement on the HRQoL several years after THR. We have recently found that after THR postoperative health awareness is influenced mainly by cardiovascular diseases, but the effects of the movement parameters on the subsequent feelings of well-being were not examined.

Cardiovascular diseases and the health-related quality of life after total hip replacement.

Aims And Objectives: To evaluate to what degree total hip replacement, or co-morbidities or their progression, influence the health-related quality of life of patients after the operation. We have looked for an objective method to reflect the severity of cardiovascular diseases and to better characterise the health-related quality of life of patients with total hip replacement.

Background: The main weakness of the different health-related quality of life methods that are applied to the analysis is the lack of information regarding the contributory role of co-morbidities, especially cardiovascular diseases.

The diagnosis of hypovolemia using advanced statistical methods.

Aim: Diagnosing hypovolemia is not a trivial task. Hypovolemia itself has several physical signs, but their specificity and sensitivity is limited, even using sophisticated monitoring techniques. However, diagnosing hypovolemia is crucial in critically ill patients to avoid worse outcomes.

Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study.

Background: Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI) continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs) in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clinical practice; and to determine the influencing factors of the development of AKI and the patients' outcomes.

[Role of cardiovascular disorders in quality of life after total hip replacement].

Unlabelled: This cohort, retrospective study, in the Jávorszky Ödön Hospital, Vác, Hungary, involved 109 patients after total hip replacement.

Methods: The applied questionnaires included the EQ-5D health-related quality of life scores, the Western Ontario and McMaster Universities Ostoearthritis Index (WOMAC) scores, the preoperative and the postoperative 5th year health characteristics. The severity of co-morbidities was graded in respect of clinical signs and pharmacological treatment.

Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients.

Background And Objective: To examine the kinetics of volume loading with crystalloid and colloid infusions in critically ill patients after major surgery, using the pulse contour cardiac output (PiCCO) monitoring technique.

Methods: This prospective, randomized, multicentre study of 11 ICUs involved 200 mixed postoperative hypovolaemic patients (50 patients per group) in Hungary. Patients received 10 ml kg of lactated Ringer's solution, succinylated gelatin 4% w/v, 130/0.

Precision of transpulmonary thermodilution: how many measurements are necessary?

Background And Objectives: To analyse the precision of transpulmonary thermodilution from the PiCCO technique (Pulsion Medical System, Munich, Germany) in everyday intensive care practice in order to ascertain the minimum number of measurements necessary for scientific precision.

Methods: An observational study in the medical-surgical ICU of a teaching hospital was performed. Thirty consecutive patients from a mixed intensive care population using the PiCCO haemodynamic monitor were included.

[Principles of intensive care in severe acute pancreatitis in 2008].

Acute pancreatitis is a dynamic, often progressive disease; 14-20% require intensive care in its severe form due to multiorgan dysfunction and/or failure. This review was created using systematic literature review of articles published on this subject in the last 5 years. The outcome of severe acute pancreatitis is determined by the inflammatory response and multiorgan dysfunction - the prognostic scores (Acute Physiology and Chronic Health Evaluation, Glasgow Prognostic Index, Sepsis-related Organ Failure Assessment, Multi Organ Dysfunction Syndrome Scale, Ranson Scale) can be used to determine outcome.

Intramucosal pH monitoring during liver transplantation.

Purpose: To apply tonometry as a quick estimation of the early liver graft function.

Patients And Methods: Forty-five liver-transplanted patients were examined. Data were collected prospectively and analysed retrospectively.

Analysis of systemic and regional procalcitonin serum levels during liver transplantation.

Elevated procalcitonin (PCT) levels are observed early after orthotopic liver transplantation (OLTx). The aim of this study was to evaluate the changes in systemic and regional PCT serum levels from the time of organ harvesting until the early postoperative phase of OLTx ( n=28) and to investigate the prognostic suitability of postoperative changes in PCT level for the outcome of OLTx ( n=61). Only in seven of 28 donors were higher PCT levels found (0.