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Purpose: We compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation.Methods: This multicenter feasibility trial randomized 100 AKI patients 1:1 in seven ICUs in Europe and Australia. Restrictive fluid management included targeting negative or neutral daily fluid balance by minimizing fluid input and/or enhancing urine output with diuretics administered at the discretion of the clinician. Fluid boluses were administered as clinically indicated. The primary endpoint was cumulative fluid balance 72 h from randomization.Results: Mean (SD) cumulative fluid balance at 72 h from randomization was - 1080 mL (2003 mL) in the restrictive fluid management arm and 61 mL (3131 mL) in the usual care arm, mean difference (95% CI) - 1148 mL (- 2200 to - 96) mL, P = 0.033. Median [IQR] duration of AKI was 2 [1-3] and 3 [2-7] days, respectively (median difference - 1.0 [- 3.0 to 0.0], P = 0.071). Altogether, 6 out of 46 (13%) patients in the restrictive fluid management arm and 15 out of 50 (30%) in the usual care arm received renal replacement therapy (RR 0.42; 95% CI 0.16-0.91), P = 0.043. Cumulative fluid balance at 24 h and 7 days was lower in the restrictive fluid management arm. The dose of diuretics was not different between the groups. Adverse events occurred more frequently in the usual care arm.Conclusions: In critically ill patients with AKI, a restrictive fluid management regimen resulted in lower cumulative fluid balance and less adverse events compared to usual care. Larger trials of this intervention are justified. [ABSTRACT FROM AUTHOR]

The authors argue for the need to consider patient safety when deciding on whether to recommend the use of hydroxyethyl starch (HES) for all indications. They discuss the basis of recommendations from the European Medicines Agency (EMA) Coordination Group for Mutual Recognition and Decentralised Procedures--Human (CMDh) that HES may be used in severe haemorrhage. A brief background on the suspension of HES licensing by the EMA Pharmacovigilance Risk Assessment Committee (PRAC) is included.

The article discusses the relevant moral issues at stake with respect to heart donation and transplantation following circulatory death. It notes that a 5-minute "no touch" period may ensure both due confirmation of a spontaneously irrecoverable dying process while offering the donor's family enough time with their deceased loved-one and greater sense and understanding of the finality of the situation. It notes how wasting time is illogical and injurious to both parties.