Journal of critical care
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Journal of critical care · Feb 2025
Postoperative oliguria after intermediate and high-risk surgeries in critical care, A cohort analysis.
Oliguria is commonly used as a cutoff for acute kidney injury (AKI), however, a decrease in urine output is common during surgery and may represent an adaptative response in the perioperative setting rather than a reduction in glomerular filtration rate, leading to a possible overestimation of postoperative AKI incidence. Although this dilemma has been addressed in the intraoperative scenario, the incidence and impact of oliguria in the first postoperative day represents a gap in the current literature. Our main goal is to describe the incidence, risk factors and clinical outcomes related to postoperative oliguria. ⋯ Postoperative oliguria is common after intermediate and high-risk surgical procedures and increases the risk of AKI. However, oliguria was largely unrelated with kidney disfunction measured by serum creatinine (87,6 %), raising doubts on whether diuresis overestimates AKI incidence in the postoperative setting.
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Journal of critical care · Feb 2025
The furosemide stress test predicts successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury.
There is still no good method for predicting renal recovery and successful discontinuation of continuous renal replacement therapy (CRRT). This study assessed the ability of the furosemide stress test (FST) to predict successful discontinuation of CRRT. ⋯ A urine output >188 mL in the first 2 h after FST predicted successful discontinuation of CRRT.
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Journal of critical care · Feb 2025
Observational StudyQuadriceps Muscle Layer Thickness and its association with frailty in critically ill patients: A prospective observational study.
Frailty is a well-recognized clinical entity known to influence the outcomes of critically ill patients. Muscle ultrasound, particularly Quadriceps Muscle Layer Thickness (QMLT), assesses muscle mass, which is a key component determining frailty. However, no studies have assessed the association between frailty and QMLT. This study aimed to determine the association between the QMLT and frailty in critically ill elderly patients. ⋯ We found an independent association between Quadriceps Muscle Layer Thickness (QMLT) and frailty. QMLT decreased progressively with CFS scores. Frail patients with lower QMLT had increased 28-day mortality. These findings highlight the role of incorporating QMLT measurements along with CFS in frailty evaluations to improve decision-making in critically ill elderly patients.
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Journal of critical care · Feb 2025
Target attainment of beta-lactam antibiotics and ciprofloxacin in critically ill patients and its association with 28-day mortality.
This study aims to assess pharmacodynamic target attainment in critically ill patients and identify factors influencing target attainment and mortality outcomes. ⋯ A high rate of target attainment (100 % ƒT>1xECOFF) for beta-lactams and a lower rate for ciprofloxacin was observed. Achieving exposures of 100 % ƒT>4xECOFF was associated with 28-day mortality. The impact of antibiotic target attainment on clinical outcome needs to be a focus of future research.
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Journal of critical care · Feb 2025
Shock prediction with dipeptidyl peptidase-3 and renin (SPiDeR) in hypoxemic patients with COVID-19.
Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown. ⋯ In patients hospitalized with COVID-19 and hypoxemia without baseline hypotension, higher baseline plasma levels of DPP3 but not renin were associated with increased risk of subsequent shock and death.