Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU:A User-Centered Design for Rapid Prototyping

Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.

Timing of Continuous Renal Replacement Therapy Initiation in Sepsis-Associated Acute Kidney Injury: A Comprehensive Review and Future Directions

This review examines the application of continuous renal replacement therapy(CRRT)in patients with sepsis-associated acute kidney injury(S-AKI),with a particular focus on the timing of CRRT initiation.This review addresses the controversy surrounding initiation timing and proposes future research directions.Through a systematic review of recent literature on CRRT for S-AKI,working principles,therapeutic mechanisms,initiation timing of CRRT,and related meta-analyses were summarized.Current studies indicate that the optimal timing for CRRT initiation in S-AKI patients remains inconclusive,with ongoing debate regarding whether early initiation significantly improves patient survival and renal function.This lack of consensus reflects the heterogeneity of the S-AKI patient population and the limitations of existing research methodologies.Future studies should focus on advancing the application of precision medicine in S-AKI and developing individualized treatment strategies by integrating multidimensional information to optimize CRRT utilization and improve patient outcomes.

Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus

Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.

Eff ects of continuous renal replacement therapy on infl ammation-related anemia, iron metabolism and prognosis in sepsis patients with acute kidney injury

BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS:Sepsis patients with AKI were prospectively enrolled and randomized into the CRRT and control groups.The clinical and laboratory data on days 1,3 and 7 after intensive care unit(ICU)admission were collected.The serum interleukin(IL)-6,hepcidin,erythropoietin,ferritin,and soluble transferrin receptor(sTfR)were determined by enzyme-linked immunosorbent assay.The Sequential Organ Failure Assessment(SOFA)score and 28-day mortality were recorded.Data were analyzed using Pearson’s Chi-square test or Fisher’s exact test(categorical variables),and Mann-Whitney U-test or t-test(continuous variables).RESULTS:The hemoglobin and serum erythropoietin levels did not signifi cantly diff er between the CRRT and control groups though gradually decreased within the first week of ICU admission.On days 3 and 7,the serum IL-6,hepcidin,ferritin,and red blood cell distribution width significantly decreased in the CRRT group compared to the control group(all P<0.05).On day 7,the serum iron was significantly elevated in the CRRT group compared to the control group(P<0.05).However,the serum sTfR did not signifi cantly diff er between the groups over time.In addition,the SOFA scores were signifi cantly lower in the CRRT group compared to the control group on day 7.The 28-day mortality did not signifi cantly diff er between the control and CRRT groups(38.0%vs.28.2%,P=0.332).CONCLUSION:CRRT might have beneficial effects on the improvement in inflammationrelated iron metabolism and disease severity during the fi rst week of ICU admission but not anemia and 28-day mortality in sepsis patients with AKI.

Effects of plasma exchange combined with continuous renal replacement therapy on acute fatty liver of pregnancy

BACKGROUND: Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The safety and effect of plasma exchange (PE)in combination with continuous renal replacement therapy(CRRT) (PE+CRRT) for AFLP still needs evaluation.METHODS: Five AFLP patients with hepatic encephalopathy and renal failure were subjected to PE+CRRT in our department from 2007 to 2012. Their symptoms, physical signs and results were observed, and all relevant laboratory tests were compared before and after PE+CRRT.RESULTS: All the 5 patients were well tolerated to the therapy. Four of them responded to the treatment and showed improvement in clinical symptoms/signs and laboratory results and they were cured and discharged home after the treatment One patient succeeded in bridging to transplantation for slowing down hepatic failure and its complications process after2 treatment sessions. Intensive care unit stay and hospital stay were 9.4 (range 5-18) and 25.0 days (range 11-42), respectively.CONCLUSION: PE+CRRT is safe and effective and should be used immediately at the onset of hepatic encephalopathy and/or renal failure in patients with AFLP.

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

When to initiate renal replacement therapy: The trend of dialysis initiation

The timing of renal replacement therapy for patients with end-stage renal disease has been subject to considerable variation. The United States Renal Data System shows an ascending trend of early dialysis initiation until 2010, at which point it decreased slightly for the following 2 years. In the 1990s, nephrologists believed that early initiation of dialysis could improve patient survival. Based on the Canadian-United States Peritoneal Dialysis study, the National Kidney Foundation Dialysis Outcomes Quality Initiative recommended that dialysis should be initiated early. Since 2001, several observational studies and 1 randomized controlled trial have found no beneficial effect when patients were placed on dialysis early. In contrast, they found that an increase in mortality was associated with early dialysis initiation. The most recent dialysis initiation guidelines recommend that dialysis should be initiated at an estimated glomerular filtration rate （eGFR） of greater than or equal to 6 mL/min per 1.73 m2. Nevertheless, the decision to start dialysis is mainly based on a predefned eGFR value, and no convincing evidence has demonstrated that patients would benefit from early dialysis initiation as indicated by the eGFR. Even today, the optimal dialysis initiation time remains unknown. The decision of when to start dialysis should be based on careful clinical evaluation.

Effects of prostaglandin E combined with continuous renal replacement therapy on septic acute kidney injury

BACKGROUND The effects of prostaglandin E(PGE)combined with continuous renal replacement therapy(CRRT)on renal function and inflammatory responses in patients with septic acute kidney injury(SAKI)remain unclear.AIM To investigate the effects of PGE combined with CRRT on urinary augmenter of liver regeneration(ALR),urinary Na+/H+exchanger 3(NHE3),and serum inflammatory cytokines in patients with SAKI.METHODS The clinical data of 114 patients with SAKI admitted to Yichang Second People's Hospital from May 2017 to January 2019 were collected.Fifty-three cases treated by CRRT alone were included in a control group,while the other 61 cases treated with PGE combined with CRRT were included in an experimental group.Their urinary ALR,urinary NHE3,serum inflammatory cytokines,renal function indices,and immune function indices were detected.Changes in disease recovery and the incidence of adverse reactions were observed.The 28-d survival curve was plotted.RESULTS Before treatment,urinary ALR,urinary NHE3,blood urea nitrogen(BUN),serum creatinine(SCr),CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio in the control and experimental groups were approximately the same.After treatment,urinary ALR and NHE3 decreased,while BUN,SCr,CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio increased in all subjects.Urinary ALR,urinary NHE3,BUN,and SCr in the experimental group were significantly lower than those in the control group,while CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio were significantly higher than those in the control group(P<0.05).After treatment,the levels of tumor necrosis factor-α,interleukin-18,and high sensitivity C-reactive protein in the experimental group were significantly lower than those in the control group(P<0.05).The time for urine volume recovery and intensive care unit treatment in the experimental group was significantly shorter than that in the control group(P<0.05),although there was no statistically significant difference in hospital stays between the two groups.The total incidence of adverse reactions did not differ statistically between the two groups.The 28-d survival rate in the experimental group(80.33%)was significantly higher than that in the control group(66.04%).CONCLUSION PGE combined with CRRT is clinically effective for treating SAKI,and the combination therapy can significantly improve renal function and reduce inflammatory responses.

Optimal indicator for changing the filter during the continuous renal replacement therapy in intensive care unit patients with acute kidney injury:A crossover randomized trial

BACKGROUND:The study aims to investigate an optimal indicator for changing the filter during the continuous renal replacement therapy(CRRT)in intensive care unit(ICU)patients with acute kidney injury(AKI).METHODS:Patients with AKI requiring CRRT in an ICU were randomly divided into two groups for crossover trial,i.e.,groups A and B.Patients in the group A were firstly treated with continuous veno-venous hemofiltration(CVVH),followed by continuous veno-venous hemodiafiltration(CVVHDF).Patients in the group B were firstly treated with CVVHDF followed by CVVH.Delivered doses of solutes with different molecular weights at the indicated time points between groups were compared.A correlation analysis between the delivered dose and pre-filter pressure(P_(PRE))and transmembrane pressure(P_(TM))was performed.Receiver operating characteristic(ROC)curves were constructed to evaluate the accuracy of P_(TM) as an indicator for filter replacement.RESULTS:A total of 50 cases were analyzed,27 in the group A and 23 in the group B.Delivered doses of different molecular-weight solutes significantly decreased before changing the filter in both modalities,compared with those at the initiation of treatment(all P<0.05).In the late stage of CRRT,the possible rebound of serum medium-molecular-weight solute concentration was observed.P_(TM) was negatively correlated with the delivered dose of medium-molecular-weight solute in both modalities.The threshold for predicting the rebound of serum concentration of medium-molecularweight solute by P_(TM) was 146.5 mm Hg(1 mm Hg=0.133 k Pa).CONCLUSIONS:The filter can be used as long as possible within the manufacturer’s safe use time limits to remove small-molecular-weight solutes.P_(TM) of 146.5 mm Hg may be an optimal indicator for changing the filter in CRRT therapies to remove medium-molecular-weight solutes.

Renal Replacement Therapy in Qatar—Past, Present and Future

The economic development of Qatar alongside the resultant lifestyle changes in the last few decades has contributed to increasing rates of obesity, diabetes mellitus and hypertension with consequent increased incidence and prevalence of chronic kidney disease and end-stage-renal-disease (ESRD). This article describes renal replacement therapy (RRT) services in Qatar and their evolution in response to challenges posed by the growth of ESRD with reference to regional and international data. It covers the history of RRT, highlighting significant advances in chronological order, as well as providing an overview of the current status of RRT in the multicultural and socioeconomically diverse society that inhabits Qatar. Finally, it casts a glance into the future, predicting how RRT services will further evolve to address the current limitations.

Evaluation of the Pharmacokinetics of Nafamostat Mesylate during Continuous Renal Replacement Therapy

Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in Japan) during CRRT in patients with high bleeding risk. In this study, we evaluated the pharmacokinetics of NM during CRRT. Patients undergoing CRRT therapy and using NM as the anticoagulant in the intensive care unit were enrolled in the study. Blood was collected from the CRRT circuit just after blood removal, just before and after the membrane for CRRT, and from the filtrates after the membrane. NM concentrations were measured using high-performance liquid chromatography. NM was detected in the intracorporeal circulation during CRRT in some cases, and liver enzymes were severely elevated in almost all of the cases. Coagulation time was prolonged even before the initiation of NM administration in these cases and may be associated with liver damage. This study suggests that NM dosage should take into account liver damage assessed by elevated liver enzymes.

Renal Replacement Therapy in Patients over 65 Years Old

Age at onset of renal replacement therapy (RRT) is increasing in all countries. Two substitution methods of renal function remain available: hemodialysis (HD) and peritoneal dialysis (PD). It was a retrospective study carried out on January 2015 and it included patients older than 65 years, monitored for HD and PD. We studied their epidemiological and clinical profile, their evolution, and the elements of prognosis. Two groups of 42 patients were included. The first was about 30 HD patients representing 25% of all patients on HD with an average age of 71 ± 4.5 years. The second was concerning 12 patients on PD having a mean age of 69.8 ± 3.5 years and representing 11.7% of all patients on PD. Functional and vital prognosis of a patient with end stage renal disease (ESRD) depends, in the elderly, on psychological, cognitive functions, and the degree of autonomy.

Renal Replacement Therapy in a Caribbean Population: The Impact of Biological, Sociocultural and Demographic Factors

Background: The options for renal replacement therapy for end stage renal disease include haemodialysis (HD), peritoneal dialysis (PD) and renal transplantation. In this study demographic, sociocultural and biological factors were assessed over a 1-year period for patients on renal replacement therapy. Methods: This cross-sectional study included all patients 18 years and older and on renal replacement therapy for at least 3 months in Trinidad and Tobago. Five hundred and thirty participants were recruited from our organ transplantation unit, all centres facilitating PD and a stratified random sample of all HD centres (100 T, 80 PD, 350 HD from October 2015 to October 2016. A questionnaire was administered and included demographics, knowledge and understanding and biological factors impacting on renal replacement therapy. Results: Thirty eight percent of all patients were between 56 to 65 years of age. The Indo Trinidadian population accounted for 51% of the subjects. 52.5% were male and 47.5% were female. From the data, 72% of patients were diabetic and/or hypertensive. In the transplant recipients, 39% were diabetic and/or hypertensive and 27% reported chronic glomerulonephritis as the aetiology of their kidney failure. The diagnosis of chronic kidney disease was made when patients were at end stage renal disease requiring intervention in 84.2% of persons. The employed population of patients constituted 65% of renal transplant recipients, 43.75% of peritoneal dialysis patients and 22.86% of haemodialysis patients. The patient’s physician had the greatest influence on renal replacement therapy choice (85.4% haemodialysis, 85% peritoneal dialysis, 71% transplant). Conclusions: In this cohort of 530 patients on renal replacement therapy, knowledge of therapy and physician’s influence were some of the factors that impacted on choice of therapy. Most patients were already de novo end stage renal disease when the diagnosis of kidney disease was made. Lifestyle diseases-type 2 diabetes mellitus and hypertension were the main causative diseases contributing to renal failure. This study which is the first in the Caribbean to evaluate biological, sociocultural and demographic factors in patients receiving renal replacement will better assist in prevention strategies and resource allocation.

Efficacy of Ulinastatin Combined with Continuous Renal Replacement Therapy in the Treatment of Sepsis Acute Kidney Injury and Its Effects on Systemic Inflammation, Immune Function and miRAN Expression

Objective: To research the effectiveness of ulinastatin in combination with continuous renal replacement therapy in treating sepsis acute kidney injury and its effect on systemic inflammation, immune function and miRAN expression. Methods: The 84 patients who were diagnosed with sepsis complicated by acute kidney injury in our hospital between May 2020 and June 2022 were chosen and randomly assigned to the study group (n = 42) and the control group (n = 42). Ulinastatin in combination with continuous renal replacement therapy was administered to the study group, whereas the control group was administered with continuous renal replacement therapy alone. Both groups’ clinical effects were observed. The levels of blood urea nitrogen (BUN), serum creatinine (SCr), tumor necrosis factor-α (TNF-α), high sensitivity Creactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1), IgG, IgA, IgM, expression levels of miR-233 and miR-10a were compared among both the groups, pre-, and post-treatment. Results: The study group’s overall effectiveness rate was higher that is 95.24%, in comparison to the control group’s 78.57%, and this difference was statistically significant (P α, hs-CRP, VCAM-1, and miR-233 and miR-10a expression levels in both the study and control groups were decreased, however, the study group had reduced levels in comparison to the control group, with statistically significant differences (P P Conclusion: Ulinastatin in combination with continuous renal replacement therapy for treating sepsis acute kidney injury exhibits a positive effect and can significantly improve the systemic inflammation and immune function in patients.

Study and observation of ultrasound on hemorheology of continuous renal replacement therapy in ICU

Objective: To observe the influence of bedside ultrasound on Hemodynamics of Continuous Renal Replacement Therapy,and explore the clinical value of bedside ultrasound technique in acute kidney injury (AKI) Patients with continuous renal replacement therapy (CRRT) and capacity management. Methods 311 cases of AKI patients with CRRT were divided randomly into Observe group and Control group. the observe group was used bedside ultrasound technique, by monitoring tricuspid annular plane systolic excursion (TAPSE), internal diameter of inferior vena cava (IVC), respiratory variation index of the inferior vena cava internal diameter (RVI) and left vertical Tei index changes. Meanwhile, each parameter change was mediated by ultrasound detection from before, to 30min, 6h, 12h, 36h, 48h after of CRRT to sustain liquid balance in observe group, however, central venous pressure (CVP) change was modulated in control group. The difference of kidney length in pre-CRRT were examined to exclude, and of renal aortic diameter, renal resistance index (RRI)and renal blood flow in post-48h of CRRT were compared in two groups. Results Renal length, Renal parenchyma thickness and Echo strength of renal parenchyma weren't different statistically in pre-CRRT of two groups(P>0.05). In observe group, the RVI level was started to increase significantly and IVC internal diameter to decrease at 6h, which would tend to stable at 36h(F=27.746 and 15.446 respectively);the TAPSE level was gradual ascending and Tei index was descending at 12h with a stable tendency at 24h of CRRT(F=36.213 and 17.127 respectively), and there was difference statistical among time of obvious change in TAPSE, IVC internal diameter, RVI and Tei index(P<0.05);In control group, there was no difference statistical among each time in CVP(F=2.189, P>0.05). Compared with control group, renal aortic diameter and renal blood flow were increased significantly(t=2.356 and 2.075), RRI was decreased obviously in observe group(t=2.244), which was different in statistics (P<0.05). Conclusion the application of bedside ultrasound technique in AKI patient's capacity management with CRRT was more effective and evaluated the kidney perfusion.

Comparative Costs of Different Renal Replacement Therapies in Lower Middle Income Countries on the Example of Georgia

End-Stage Renal Disease (ESRD) represents one of the most challenging social and medical problems mainly due to substantial treatment-associated costs. The chronic nature of the disease needs expensive continuous care that majority of the patients cannot afford. Therefore, in many countries expenses associated with the ESRD treatment is paid by state government. These treatment options include: hemodialysis, peritoneal dialysis and kidney transplantation. Multiple studies have been conducted throughout the world to assess cost-effectiveness of these treatment modalities. The studies suggest that kidney transplantation not only reduces mortality and morbidity but improves a quality of life of ESRD patients. Furthermore, it is the most cost-effective treatment for the ESRD at least in high-income countries. The goal of our study was to determine whether above-mentioned is true for lower middle income countries, where the cost of the ESRD treatment is substantially lower. Despite the low dialysis costs, transplantation remains the cheapest form of renal replacement therapy RRT in lower income countries like Georgia. Our results reveal, that kidney transplantation is most expensive modality of Renal Replacement Therapy (RRT) at month 1, but count of costs reveals that after the 10th month of treatment, the cumulative cost of transplantation is less than the cumulative cost of peritoneal dialysis and after the 23rd month, cumulative cost of hemodialysis also surpasses the cumulative cost of transplantation-related treatment and this cost comparison is in line with global data from upper-middle and high income countries.

The Risk of Severe Acute Kidney Injury Requiring Renal Replacement Therapy in Viral Hemorrhagic Fevers. A Review of Literature

Objective: It demonstrates the correlation of the viral hemorrhagic fever with kidney failure and the treatment as well as the outcome. Method: A PubMed search of the English literature from 1999 to 2019 was performed using “viral hemorrhagic fever, Case Report, Renal Failure” as the subject. The inclusion criteria were the following: 1) case report and case series of two or more patients;2) the report detailed the clinical presentation and reported the status of the renal system;3) the report described the management of renal failure if any;and 4) the etiology of the infection is known and is one of the known agents of viral hemorrhagic fever, listed on the centers of disease control website. We excluded infections related to vaccination related to viral hemorrhagic fever. Result: We found the mean age of these patients was 41.5. The male to female ratio was about 3.5:1. Dengue and Hantaviruses constituted 70.5% of patients. The overall mortality of the study cohort was 32.2%. Half of the patients had acute kidney injury and required renal replacement therapy. The chi-square statistic is 0.41;The p-value is 0.51;The chi-square statistic is 6.4254. Overall mortality was 32.3% in one cohort of 78 patients. The illness goes through several stages [1] [2] of clinical features and some viruses in the group have a high case fatality rate. Conclusions: Early diagnosis with aggressive supportive care is critical for improving clinical outcomes. Renal involvement is common. Amongst the cohort reviewed, of patients who had acute kidney injury, half of the patients required renal replacement support. However, some viruses cause greater kidney injury than others, for instance, kidney injury is more severe in Dengue hemorrhagic fevers when compared to Hantaviruses. Simultaneous management of public health by prevention and control of outbreaks is particularly important.

Effect of Xuebijing combined with early continuous renal replacement therapy on systemic inflammatory response and renal impairment in patients with heat stroke

Objective: To study the effect of Xuebijing combined with early continuous renal replacement therapy on systemic inflammatory response and renal impairment in patients with heat stroke. Methods: A total of 24 patients with heat shock who were treated in Qidong People's Hospital between June 2015 and August 2017 were selected an9d randomly divided into two groups, Xuebijing group received Xuebijing combined with early continuous renal replacement therapy, and control group received early continuous renal replacement therapy. Serum levels of inflammatory response cytokines, coagulation-related cytokines and renal function indicators of two groups of patients were detected before treatment as well as 3 d and 6 d after treatment. Results: Serum TNF-α, IL-6, IL-17, hs-CRP, TF, sTM, sE-selectin, BUN, Scr, β2-MG and Cys-C levels of both groups 3 d and 6 d after treatment were significantly lower than those before treatment, and serum TNF-α, IL-6, IL-17, hs-CRP, TF, sTM, sE-selectin, BUN, Scr, β2-MG and Cys-C levels of Xuebijing group 3 d and 6 d after treatment were significantly lower than those of control group. Conclusion: Xuebijing combined with early continuous renal replacement therapy can reduce the degree of systemic inflammatory response and renal impairment in patients with heat stroke.

A Liquid Chromatography Assay for the Simultaneous Quantification of Piperacillin and Ciprofloxacin in Human Plasma and Dialysate in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Piperacillin/tazobactam and ciprofloxacin are often used in combination as initial empiric anti-biotic therapy in critical ill patients. Especially in patients undergoing continuous renal replacement therapy (CRRT) the pharmacokinetics of antimicrobial agents can be highly variable. In order to avoid under- or overdosage of antibiotics therapeutic drug monitoring (TDM) is highly re-commendable. Based on two known HPLC assays for piperacillin a new method in combination with solid phase extraction (SPE) for the simultaneous determination of piperacillin and ciprofloxacin was developed. Method validation was performed according to the EMA guideline on validation of bioanalytical methods. The HPLC column used was a Perfect Bond ODS-HD C18 analytical column (100 mm × 4.6 mm i.d., particle size 5 μm), equipped with a guard column (10 mm × 4.6 mm, particle size 5 μm) containing the same packing material. Detection wavelength was set at 228 nm for piperacillin and benzylpenicillin was used as internal standard (IS). Ciprofloxacin was determined at two wavelengths (280 nm, 315 nm). This newly developed HPLC method in combination with SPE-extraction allows an accurate, precise, specific and efficient determination of piperacillin and ciprofloxacin in biological matrices. Results allow the calculation of all relevant pharmacokinetic data for critically ill patients undergoing CRRT and the optimization of dosing and TDM.

An integrative risk assessment approach to enhancing patient safety in Continuous Renal Replacement Therapy(CRRT)

Continuous Renal Replacement Therapy(CRRT)serves as an intervention strategy for the management of acute kidney injury(AKl)in critically ill patients.However,owing to its complex nature and the potential for com-plications,the implementation of CRRT demands continuous monitoring to prevent patient safety risks.This study aims to identify and validate prevalent risks linked to CRRT within a real-world clinical setting,intending to propose preventive measures grounded in expert insights.To systematically categorize and visually depict the risks,their consequences,preventive measures,and recovery controls,our study employed the Bowtie method in conjunction with the Systems Engineering Initiative for Patient Safety(SEIPS)model.In addition to considering patient-related factors that exhibit variability among critically ill individuals,our key findings showed that the most influential risks impacting the effective delivery of CRRT are incidents of clotted filters,bleeding risks arising from the necessity of anticoagulation for filter efficacy,vascular catheter-related bloodstream infections,variations in proficiency levels among healthcare professionals regarding CRRT modalities,especially in oper-ating the CRRT machines,high nursing workload,frequent nursing turnover,occurrences of hypophosphatemia,variability in CRRT prescribing patterns,and issues related to communication among stakeholders.This research sheds light on the primary risks associated with CRRT and provides practical and viable strategies for effective management.Furthermore,the Bowtie diagram developed as part of this study serves as a valuable tool for visually representing the healthcare system and facilitating the identification of system-related risks within healthcare settings.