Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

Criteria deemed important by ICU patients when designating a reference person

Background:We investigated the criteria that hospitalized patients in intensive care units(ICUs)deem important when designating relatives who are best qualified to interact with the caregiving staff.Methods:We conducted an exploratory,observational,prospective,multicenter study between March 1,2018,and October 31,2018,within two ICUs.A 12-item questionnaire was distributed to patients in the ICUs by the investigating physicians.Patients were considered eligible if they had a good understanding of the French language and if they had not officially designated surrogates before ICU admission.Results:Seventy-one patients whose average age was 63.9±17.3 years,of whom 21(29.5%)were females,completed the questionnaire.The average Charlson comorbidity score was 2.5±2.4,and the average Simplified Acute Physiology Score(SAPS II)was 39.8±16.5.The main etiology was respiratory infection(40.8%),followed by sepsis(23.9%).The most important criteria identified by patients when selecting reference persons were a good knowledge of the patient’s wishes and values,an emotional attachment to the patient,and being a family member.Conclusion:Our findings reveal that ICU patients considered the following criteria to be critical when designating reference persons:knowledge of their wishes and the existence of emotional and family attachments.