Quality, safety, and implementation science in acute kidney care
Purpose of review
Quality and safety are important themes in acute kidney care (AKC). There have been many recent initiatives highlighting these aspects. However, for these to become part of clinical practice, a rigorous implementation science methodology must be followed. This review will present these practices and will highlight recent initiatives in acute kidney injury (AKI), kidney replacement therapy (KRT) and recovery from AKI.
Recent findings
The 22nd Acute Disease Quality Initiative (ADQI) focused on achieving a framework for improving AKI care. This has led to various quality improvement (QI) initiativ...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: RENAL SYSTEM: Edited by Sean M. Bagshaw Source Type: research
Opportunities in digital health and electronic health records for acute kidney injury care
Purpose of review
The field of digital health is evolving rapidly with applications relevant to the prediction, detection and management of acute kidney injury (AKI). This review will summarize recent publications in these areas.
Recent findings
Machine learning (ML) approaches have been applied predominantly for AKI prediction, but also to identify patients with AKI at higher risk of adverse outcomes, and to discriminate different subgroups (subphenotypes) of AKI. There have been multiple publications in this area, but a smaller number of ML models have robust external validation or the ability to run in real-t...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: RENAL SYSTEM: Edited by Sean M. Bagshaw Source Type: research
Subphenotypes of acute kidney injury in adults
Purpose of review
Acute kidney injury is a heterogeneous syndrome and as such is associated with multiple predisposing conditions and causes all of which affect outcomes. Such heterogeneity may conceal the potential benefit of therapies when generally applied to patients with acute kidney injury (AKI). The discovery of pathophysiology-based subphenotypes could be of benefit in allocating current and future therapies to specific groups.
Recent findings
Clinical subphenotypes group patients into categories according to predisposing factors, disease severity, and trajectory. These may be helpful in assessing patien...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: RENAL SYSTEM: Edited by Sean M. Bagshaw Source Type: research
Subphenotypes of acute kidney injury in children
Purpose of review
The purpose of this review is to describe acute kidney injury (AKI) phenotypes in children.
Recent findings
AKI is a heterogenous disease that imposes significant morbidity and mortality on critically ill and noncritically ill patients across the age spectrum. As our understanding of AKI and its association with outcomes has improved, it is becoming increasingly apparent that there are distinct AKI subphenotypes that vary by cause or associated conditions. We have also learned that severity, duration, and repeated episodes of AKI impact outcomes, and that integration of novel urinary biomarkers...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: RENAL SYSTEM: Edited by Sean M. Bagshaw Source Type: research
Fluid balance in pediatric critically ill patients (with and without kidney dysfunction)
Purpose of review
The issues of fluid balance and fluid overload are currently considered crucial aspects of pediatric critically ill patients’ care.
Recent findings
This review describes current understanding of fluid management in critically ill children in terms of fluid balance and fluid overload and its effects on patients’ outcomes. The review describes current evidence surrounding definitions, monitoring, and treatment of positive fluid balance. In particular, the review focuses on specific patient conditions, including perioperative cardiac surgery, severe acute respiratory failure, and extracorporea...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: RENAL SYSTEM: Edited by Sean M. Bagshaw Source Type: research
Editorial: Renal system section in current opinion in critical care: pathways forward for innovation in acute kidney injury
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: RENAL SYSTEM: Edited by Sean M. Bagshaw Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
Long-term recovery after critical illness in older adults
Purpose of review
The population is aging, and recent epidemiologic work reveals that an increasing number of older adults are presenting to the ICU with preexisting geriatric syndromes. In this update, we discuss recent literature pertaining to the long-term recovery of older ICU patients and highlight gaps in current knowledge.
Recent findings
A recent longitudinal study demonstrated that the incidence of frailty, disability, and multimorbidity among older ICU patients is rising; these geriatric syndromes have all previously been shown to impact long-term recovery. Recent studies have demonstrated the impact o...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by Catherine L. Hough Source Type: research
Healthcare delivery and recovery after critical illness
Purpose of review
To summarize improvements and innovations in healthcare delivery which could be implemented to improve the recovery experience after critical illness for adult survivors and their families.
Recent findings
For survivors of critical illness, the transitions in care during their recovery journey are points of heightened vulnerability associated with adverse events. Survivors of critical illness often have errors in the management of their medications during the recovery period. A multicomponent intervention delivered for 30 days that focused on four key principles of improved recovery care after ...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by Catherine L. Hough Source Type: research
Social determinants of recovery
Purpose of review
The purpose of this review is to examine evidence describing the influence of social determinants on recovery following hospitalization with critical illness. In addition, it is meant to provide insight into the several mechanisms through which social factors influence recovery as well as illuminate approaches to addressing these factors at various levels in research, clinical care, and policy.
Recent findings
Social determinants of health, ranging from individual factors like social support and socioeconomic status to contextual ones like neighborhood deprivation, are associated with disabilit...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by Catherine L. Hough Source Type: research
Antimicrobial stewardship
Purpose of review
The optimal use of antimicrobials is necessary to slow resistance development and improve patient outcomes. Antimicrobial stewardship (AMS) is a bundle of interventions aimed at promoting the responsible use of antiinfectives. The ICU is an important field of activity for AMS because of high rates of antimicrobial use, high prevalence of resistant pathogens and complex pharmacology. This review discusses aims and interventions of AMS with special emphasis on the ICU.
Recent findings
AMS-interventions can improve the quality and quantity of antimicrobial prescribing in the ICU without compromisi...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
Severe infections in recipients of cancer immunotherapy: what intensivists need to know
Purpose of review
Given the increased number of cancer patients admitted in the ICU and the growing importance of immunotherapy in their therapeutic arsenal, intensivists will be increasingly confronted to patients treated with immunotherapies who will present with complications, infectious and immunologic.
Recent findings
Apart from their specific immunologic toxicities, cancer immunotherapy recipients also have specific immune dysfunction and face increased infectious risks that may lead to intensive care unit admission.
Summary
Chimeric antigen receptor T-cell therapy is associated with profound immuno...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
The role of proteomics and metabolomics in severe infections
Purpose of review
Severe infections are a common cause of ICU admission, with a high morbidity and mortality. Omics, namely proteomics and metabolomics, aim to identify, characterize, and quantify biological molecules to achieve a systems-level understanding of disease. The aim of this review is to provide a clear overview of the current evidence of the role of proteomics and metabolomics in severe infections.
Recent findings
Proteomics and metabolomics are technologies that are being used to explore new markers of diagnosis and prognosis, clarify mechanisms of disease, and consequently discover potential target...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
New antimicrobial treatment options for severe Gram-negative infections
Purpose of review
This review will provide rationale for the development of new antibiotics to treat severe or multidrug-resistant (MDR) Gram-negative infections. It will also provide an overview of recently approved and pipeline antibiotics for severe/MDR Gram-negative infections.
Recent findings
MDR Gram-negative infections are recognized as critical threats by global and national organizations and carry a significant morbidity and mortality risk. Increasing antibiotic resistance amongst Gram-negative bacteria, including carbapenem-resistant Acinetobacter baumannii, extended-spectrum β-lactamase-producing Ent...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
Antibiotics: it is all about timing, isn’t it?
Purpose of review
Sepsis guidelines and quality measures set aggressive deadlines for administering antibiotics to patients with possible sepsis or septic shock. However, the diagnosis of sepsis is often uncertain, particularly upon initial presentation, and pressure to treat more rapidly may harm some patients by exposing them to unnecessary or inappropriate broad-spectrum antibiotics.
Recent findings
Observational studies that report that each hour until antibiotics increases mortality often fail to adequately adjust for comorbidities and severity of illness, fail to account for antibiotics given to uninfected...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
