Introduction: Renal replacement therapy (RRT) is a complex and expensive form of life-sustaining therapy, reserved for our most acutely ill patients. While a number of randomised trials have evaluated the optimal timing to start RRT among critically ill patients in the intensive care unit (ICU), there has been a paucity of trials providing guidance on when and under what circumstances to ideally liberate a patient from RRT. We are conducting a systematic review and meta-analysis to identify clinical and biochemical markers that predict kidney recovery and successful liberation from acute RRT among critically ill patients with acute kidney injury.
Methods And Analysis: Our comprehensive search strategy was developed in consultation with a research librarian and independently peer-reviewed by a second librarian. We will search electronic databases: Ovid Medline, Ovid Embase and Wiley Cochrane Library. Selected grey literature sources will also be searched. Our search strategies will focus on concepts related to RRT (ie, intermittent haemodialysis, slow low-efficiency dialysis, continuous renal replacement therapy), intensive care (ie, involving any ICU setting) and discontinuation of therapy (ie, either clinical, physiological and biochemical parameters of weaning acute RRT) from 1990 to October 10, 2017. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. Studies will, where possible, be pooled in statistical meta-analysis. When deemed sufficiently clinically homogenous, and we have four or more studies reporting, sensitivities and specificities will be pooled simultaneously using a hierarchical summary receiver operator characteristic curve and bivariate analysis.
Ethics And Dissemination: Our systematic review will synthesise the literature on clinical and biochemical markers that predict liberation from RRT. Research ethics approval is not required.
Trial Registration Number: CRD42018074615.
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http://dx.doi.org/10.1136/bmjopen-2018-023306 | DOI Listing |
Intensive Care Med Exp
January 2025
Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Purpose: CytoSorb® (CS) adsorbent is a hemoadsorption filter for extracorporeal blood purification often integrated into continuous kidney replacement therapy (CKRT). It is primarily used in critically ill patients with sepsis and related conditions, including cytokine storms and systemic inflammatory responses. Up to now, there is no evidence nor recommendation for the use of CS filters in sepsis (22).
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January 2025
Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Purpose: This qualitative study investigated the needs, barriers, and facilitators that affect primary care providers' involvement in supporting patients' stay-at-work and return-to-work following injury or illness. It also aims to understand the lived experiences of primary care providers who participated in the Extension for Community Healthcare Outcomes training program for Occupational and Environmental Medicine (ECHO OEM). By examining both the structural and experiential aspects of the program, this study seeks to provide insights into how ECHO OEM influences providers' approaches to occupational health challenges.
View Article and Find Full Text PDFAm J Hosp Palliat Care
January 2025
Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore.
Background: In their care of terminally ill patients, palliative care physicians and oncologists are increasingly predisposed to physical and emotional exhaustion, or compassion fatigue (CF). Challenges faced by physicians include complex care needs; changing practice demands, and sociocultural contextual factors. Efforts to better understand CF have, however, been limited.
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January 2025
Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The Valsalva manoeuvre is widely recognised for its effectiveness in reverting supra-ventricular tachycardia (SVT) in patients with good coordination. However, this is not applicable in sedated ventilated patients and there is a dearth of literature regarding the application of Valsalva in unconscious patients on mechanical ventilation. The authors, for the first time, present a novel non-pharmacological method to treat SVT in critically ill patients on mechanical ventilation, employing the high positive end-expiratory pressure (PEEP) technique.
View Article and Find Full Text PDFAm J Case Rep
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Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
BACKGROUND Acalculous cholecystitis is a rare form of gallbladder inflammation that occurs without the presence of gallstones. It primarily affects critically ill patients and warrants prompt treatment given its association with high mortality. Pericarditis, an inflammation of the pericardium, typically arises from viral infections but can also be secondary to rheumatological, malignant, or bacterial causes.
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