Background: Continuous renal replacement therapy (CRRT) is a complex and life-sustaining therapy, reserved for our most acutely ill patients, and should be delivered in a safe, consistent and high-quality manner. However valid evidence-based quality indicators (QIs) for CRRT care are lacking. The objective of this study was to develop a prioritized list of QIs for CRRT care that may be used in any CRRT program.
Method: We conducted a modified three stage Delphi process. This consisted of two web-based rounds followed by an in-person meeting. We recruited an interdisciplinary panel of critical care nephrology experts and knowledge users. In each stage of the Delphi process panelists responded on whether a QI should be included in our final list. In the third round, any QI for which there was uncertainty to include was discussed and a final decision on whether to include was made.
Results: Forty-one panelists participated (18 from nephrology, 11 from intensive care, 7 educators, 2 decision-makers, 2 industry representatives and 1 pharmacist) from North America, Europe, Australasia and South America. Following the third Delphi round, 13 QIs for CRRT care were identified; 10 QIs were identified with a high level of agreement for face validity while 3 QIs were identified with a moderate level of agreement for face validity among panelists.
Conclusions: We developed a prioritized list of 13 QIs for CRRT care. Future work should focus on developing validated benchmarks for these QIs and implementing them into CRRT programs.
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http://dx.doi.org/10.1016/j.jcrc.2018.06.023 | DOI Listing |
Life (Basel)
January 2025
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea.
The optimal management of hospital-presenting sepsis remains poorly understood. We investigated the initial management in patients presenting with sepsis in the general ward, the association between fluid resuscitation and clinical outcomes, and the factors affecting fluid resuscitation. A retrospective study was conducted on patients who presented with sepsis-induced hypotension in the general ward.
View Article and Find Full Text PDFBiomedicines
January 2025
Obstetrics and Gynecology, Anesthesia and Intensive Care, Department 14, School of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania.
Unlabelled: Severe inflammation leading to organ dysfunction is the cornerstone of the pathophysiology of sepsis. Thus, from a theoretical point of view, rebalancing inflammation has the potential to improve patient outcomes.
Methods: To better understand the clinical effectiveness of hemoadsorption in managing inflammation, we conducted an updated meta-analysis on the effects of CytoSorb in critically ill septic patients.
Beijing Da Xue Xue Bao Yi Xue Ban
February 2025
Department of Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
This study reports the diagnosis and treatment of a 26-year-old pregnant woman with severe malnutrition combined with acute pyelonephritis causing sepsis, refractory septic shock and multiple organ failure. A female patient, 26 years old, was admitted to hospital mainly due to "menelipsis for more than 19 weeks, nausea and vomiting for 20 days, fever with fatigue for 3 days". At the end of 19 weeks of intrauterine pregnancy, the patient presented with fever accompanied by urinary tract irritation.
View Article and Find Full Text PDFEur J Trauma Emerg Surg
January 2025
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8677, Japan.
Purpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is beneficial for uncontrollable torso bleeding; however, prolonged REBOA causes ischemia-reperfusion injury. The purpose of this study is to examine the hypothesis that continuous renal replacement therapy (CRRT) with a cytokine-adsorbing hemofilter would improve mortality due to hemorrhagic shock with REBOA-reperfusion injury by controlling metabolic acidosis, hyperkalemia, and hypercytokinemia.
Methods: Hemorrhagic shock with 40% blood loss was induced by phlebotomy in eight female swine.
Am J Case Rep
January 2025
Department of Anesthesiology and Intensive Care, Legionowo Hospital, Military Institute of Medicine - National Research Institute, Warsaw, Poland.
BACKGROUND Extracorporeal blood purification strategies were recently developed as adjunctive treatments for sepsis. CytoSorb® is an approved medical device designed to reduce blood levels of inflammatory cytokines. The oXiris high-adsorption membrane filter is used in continuous hemofiltration adsorption.
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