Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2
Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2
Acute Kidney InjuryWilliam J Sauer and Andrew L LundquistI.DEFINITIONA. The RIFLE criteria (Risk. Injury, Failure, Loss, and ESRD) were developed in 2 Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 22004 to standardize the definition of acute kidney injury (AKI), formerly called acute renal failure (ARF). Prior to this, no consensus was available on the diagnosis or degree of severity.1Several modifications were introduced by die Acute Kidney Injury Network (AKIN) soon after, though the main ad Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2dition with AKIN was a more inclusive Stage 1 (>0.3 mg’dL increase in Cr).2In 2012, the Kidney Disease Improving Global Outcomes (KDIGO) organizationEbook Critical care handbook of the massachusetts general hospital (6/E): Part 2
published clinical practice guidelines to create a unified definition with the goal to improve outcome staging and future clinical research (since RIFAcute Kidney InjuryWilliam J Sauer and Andrew L LundquistI.DEFINITIONA. The RIFLE criteria (Risk. Injury, Failure, Loss, and ESRD) were developed in 2 Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2e helpful when assessing severity of injury and level of management (Fig. 23.1).4Serum creatinine criteria: well validated, but discrepancies exist between various definitions (e.g., misclassification of AKI using AKIN with postsurgical ICU patients after cardiopulmonary bypass with significant posi Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2tive fluid balance resulting in hemodilution).5Urine volume criteria are the same for all three (RIFLE/AKIN/KDIGO) but oftentimes it is less accurateEbook Critical care handbook of the massachusetts general hospital (6/E): Part 2
(e.g., morbid obesity).6Validation studies are currently underway to establish the utility of these guidelines— particularly with regard to diagnosis Acute Kidney InjuryWilliam J Sauer and Andrew L LundquistI.DEFINITIONA. The RIFLE criteria (Risk. Injury, Failure, Loss, and ESRD) were developed in 2 Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2esidual confounding (e.g., variability in baseline measures, the use of diagnostic code results), as well as ascertainment bias (AKI vs. CKD. which have different pathophysiologic processes and outcome data), results in differences in reported incidence and outcome measurements.B.Even with the above Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2 definitions, studies demonstrate significant differences in the incidence of AKI in die ICU when comparing die same populations.c.Nonetheless, AKI isEbook Critical care handbook of the massachusetts general hospital (6/E): Part 2
common in botli hospitalized (5%-20%) and critically ill (30%-40%) patient populations.D. Higher level of severity in AKI classification (by any of dAcute Kidney InjuryWilliam J Sauer and Andrew L LundquistI.DEFINITIONA. The RIFLE criteria (Risk. Injury, Failure, Loss, and ESRD) were developed in 2 Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2ndependent risk factor for cardiovascular complrequiring renal-replacement therapy reveals an in-hospital mortality of 50% to 75%.Studies have revealed that up to 28% of surviving AKI patients died after discharge from the hospital (i.e., in-hospital mortality likely underestimates the significance Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2of disease).E AKI patients often regain renal function with supportive therapy; however, studies have demonstrated more severe AKI, longer AKI duratioEbook Critical care handbook of the massachusetts general hospital (6/E): Part 2
n, and numerous episodes of AKI are associated with progression to CKD and increasing morality. Future insults are much less well tolerated in these pAcute Kidney InjuryWilliam J Sauer and Andrew L LundquistI.DEFINITIONA. The RIFLE criteria (Risk. Injury, Failure, Loss, and ESRD) were developed in 2 Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2---------------------------——----------------------------------Urine OutputRIFLEAKINKDIGOCriteria1—R>1.5 X baseline or GFR decrease >25%>0.3 mg/dL increase or al.5-2 X baselineI.5-1.9 X baseline or >03 mg/dL increase (within 48 h)<0.5 mưkg/h for 6-12 h44958>2 X baseline or GFR decrease >50%>2 3 X ba Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2seline2 2.9 X baseline<0.5 mL/kg/h for 12 h3—F>3 X baseline or>3 X baseline or3 X baseline or<0.3 mUkg/hLCf >4 mg/dLwith an acute rise >0.5 mg'dL LossEbook Critical care handbook of the massachusetts general hospital (6/E): Part 2
of renal function >4 wk^4.0 mg/dL with acute increase of <0.5 mg/dL or initiation of RRTincrease in serum Cr >4 mg/dl or initiation of RRTfor 24 h orAcute Kidney InjuryWilliam J Sauer and Andrew L LundquistI.DEFINITIONA. The RIFLE criteria (Risk. Injury, Failure, Loss, and ESRD) were developed in 2 Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2leEnsure volume status and perfusion pressureConsider functional homodynamic rrMonitor serum creatinine and urine output_______________Avoid hyperglycemia______________’__________ Ebook Critical care handbook of the massachusetts general hospital (6/E): Part 2Acute Kidney InjuryWilliam J Sauer and Andrew L LundquistI.DEFINITIONA. The RIFLE criteria (Risk. Injury, Failure, Loss, and ESRD) were developed in 2Gọi ngay
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