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8. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Author

Joannidis, M., Druml, W., Forni, L. G., Groeneveld, A. B. J., Honore, P. M., Hoste, E., and Ostermann, M.

Subjects
Fresenius Medical Care AG & Company KGaA, Cardiovascular agents -- Health aspects, Statins -- Health aspects, Mortality -- United Kingdom -- Canada, Diuretics -- Health aspects, Health care industry
Abstract

Background Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity. Objectives To determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles. Method A systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system. Results We formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65-70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely. Conclusion The results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes., Author(s): M. Joannidis [sup.1], W. Druml [sup.2], L. G. Forni [sup.3], A. B. J. Groeneveld, P. M. Honore [sup.4], E. Hoste [sup.5], M. Ostermann [sup.6], H. M. Oudemans-van Straaten [sup.7], [...]

Published
2017
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16. Thiaminmangel als Ursache der Laktazidose

Author

Madl, Ch., Kranz, A., Druml, W., Lenz, K., Lenz, Kurt, editor, Laggner, Anton N., editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schneeweiß, Bruno, editor, Schuster, Hans-Peter, editor, and Waldhäusl, Werner, editor

Published
1994
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17. Hämofiltration bei ARDS

Author

Druml, W., Laggner, A. N., Lenz, Kurt, editor, Laggner, Anton N., editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans-Peter, editor, Simbruner, Georg, editor, and Slany, Jörg, editor

Published
1993
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18. Das hämatopoetische System im Rahmen des Multiorganversagens

Author

Kier, P., Kabrna, E., Geissler, K., Grimm, G., Schneeweiß, B., Ratheiser, K., Laggner, A., Druml, W., Schwarzinger, I., Eichinger, S., Wiltschke, Ch., Frass, M., Leithner, Ch., Lechner, K., Lenz, K., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schneeweiß, Bruno, editor, Schuster, Hans-Peter, editor, Simbruner, Georg, editor, and Slany, Jörg, editor

Published
1992
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19. Multi-Organ-Versagen: das Versagen der Zelle

Author

Druml, W., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schneeweiß, Bruno, editor, Schuster, Hans-Peter, editor, Simbruner, Georg, editor, and Slany, Jörg, editor

Published
1992
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21. Bakterielle Translokation

Author

Druml, W., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Gadner, Helmut, editor, Graninger, Wolfgang, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans-Peter, editor, and Zaunschirm, Harald Andrew, editor

Published
1991
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22. EDV-unterstützte Auswertung bakteriologischer Befunde einer internistischen Intensivstation

Author

Vedovelli, H., Lenz, Kurt, Graninger, W., Perkmann, W., Reichetzeder, Ch., Dorda, W., Kleinberger, G., Druml, W., Laggner, A. N., Grimm, G., Schneeweiß, B., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Gadner, Helmut, editor, Graninger, Wolfgang, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans-Peter, editor, and Zaunschirm, Harald Andrew, editor

Published
1991
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23. EDV-unterstützte Analyse bakteriologischer Daten zur Erfassung von Resistenzänderungen an einer internistischen Intensivstation

Author

Vedovelli, H., Lenz, K., Graninger, W., Druml, W., Laggner, A., Grimm, G., Janata, O., Madl, Ch., Schneeweiß, B., Reichetzeder, Ch., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Gadner, Helmut, editor, Graninger, Wolfgang, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans-Peter, editor, and Zaunschirm, Harald Andrew, editor

Published
1991
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25. Verlauf und Therapie der viralen Meningoenzephalitis

Author

Grimm, G., Madl, Ch., Oder, W., Laggner, A. N., Lenz, K., Druml, W., Schneeweiß, B., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Binder, Heinrich, editor, Gadner, Helmut, editor, Grimm, Georg, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans Peter, editor, and Zaunschirm, Harald Andrew, editor

Published
1990
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26. Hitzschlag: Diagnose und Intensivtherapie

Author

Laggner, A. N., Lenz, K., Bognar, H., Druml, W., Schneeweiß, B., Grimm, G., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Binder, Heinrich, editor, Gadner, Helmut, editor, Grimm, Georg, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans Peter, editor, and Zaunschirm, Harald Andrew, editor

Published
1990
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27. Cytidindiphosphocholin bei hypoxisch-ischämischer Enzephalopathie

Author

Grimm, G., Madl, Ch., Druml, W., Laggner, A. N., Lenz, K., Schneeweiß, B., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Binder, Heinrich, editor, Gadner, Helmut, editor, Grimm, Georg, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans Peter, editor, and Zaunschirm, Harald Andrew, editor

Published
1990
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28. Intensivbehandlung des Tetanus: Erfolg und Komplikationen

Author

Laggner, A. N., Lenz, K., Göttfried, I., Base, W., Grasl, M., Druml, W., Grimm, G., Schneeweiß, B., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Binder, Heinrich, editor, Gadner, Helmut, editor, Grimm, Georg, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans Peter, editor, and Zaunschirm, Harald Andrew, editor

Published
1990
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29. Intensivmedizinische Probleme in der Behandlung des Guillain-Barré-Syndromes

Author

Druml, W., Lechner, M., Grimm, G., Laggner, A. N., Lenz, K., Schneeweiß, B., Lenz, Kurt, editor, Laggner, Anton N., editor, Deutsch, Erwin, editor, Binder, Heinrich, editor, Gadner, Helmut, editor, Grimm, Georg, editor, Kleinberger, Gunther, editor, Ritz, Rudolf, editor, Schuster, Hans Peter, editor, and Zaunschirm, Harald Andrew, editor

Published
1990
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34. Fieber bei Intensivpatienten

Author

Druml W

Subjects
Hyperthermia, business.industry, Critically ill, Hemodynamics, Emergency Nursing, Thermoregulation, Hypothermia, Critical Care and Intensive Care Medicine, medicine.disease, Intensive care unit, Fever therapy, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesia, Critical illness, Emergency Medicine, Internal Medicine, medicine, 030212 general & internal medicine, medicine.symptom, business
Abstract

Fever, arbitrarily defined as a core body temperature >38.3 °C, is present in 20-70 % of intensive care unit patients. Fever caused by infections is a physiologic reset of the thermostatic set-point and is associated with beneficial consequences, but may have negative sequelae with temperatures >39.5 °C. Fever of non-infectious and neurologic origin affects about 50 % of patients with elevated body temperature, presents as a pathologic loss of thermoregulation, and may be associated with untoward side effects at temperatures above 38.5-39.0 °C. Cooling can be achieved by physical and pharmacologic means. Evidence-based recommendations are not available. The indication for a cooling therapy can only be based on the physiologic reserve and the neurologic, hemodynamic, and respiratory state. The temperature should be lowered to the normothermic range. Hyperthermia syndromes require immediate physical cooling (and dantrolen when indicated).

Published
2018

36. Parenteral nutrition in patients with renal failure – Guidelines on Parenteral Nutrition, Chapter 17

Author

Druml, W., Kierdorf, H. P., and Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine

Subjects
acute renal failure, chronic renal failure, haemodialysis, peritoneal dialysis, Medicine
Abstract

Partial EN (enteral nutrition) should always be aimed for in patients with renal failure that require nutritional support. Nevertheless PN (parenteral nutrition) may be necessary in renal failure in patient groups with acute or chronic renal failure (ARF or CRF) and additional acute diseases but without extracorporeal renal replacement therapy, or in patients with ARF or CRF with additional acute diseases on extracorporeal renal replacement therapy, haemodialysis therapy (HD), peritoneal dialysis (PD) or continuous renal replacement therapy (CRRT), or in patients on HD therapy with intradialytic PN. Patients with renal failure who show marked metabolic derangements and changes in nutritional requirements require the use of specifically adapted nutrient solutions. The substrate requirements of acutely ill, non-hypercatabolic patients with CRF correspond to those of patients with ARF who are not receiving any renal replacement patients therapy (utilisation of the administered nutrients has to be monitored carefully). In ARF patients and acutely ill CRF patients on renal replacement therapy, substrate requirements depend on disease severity, type and extent/frequency of extracorporeal renal replacement therapy, nutritional status, underlying disease and complications occurring during the course of the disease. Patients under HD have a higher risk of developing malnutrition. Intradialytic PN (IDPN) should be used if causes of malnutrition cannot be eliminated and other interventions fail. IDPN should only be carried out when modifiable causes of malnutrition are excluded and enhanced oral (like i.e. additional energy drinks) or enteral supply is unsuccessful or cannot be carried out.

Published
2009

37. Intensive medicine – Guidelines on Parenteral Nutrition, Chapter 14

Author

Kreymann, G., Jauch, K. W., Druml, W., Adolph, M., and Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine

Subjects
substrate supply, critically ill, sepsis, intensive care, Medicine
Abstract

In intensive care patients parenteral nutrition (PN) should not be carried out when adequate oral or enteral nutrition is possible. Critically ill patients without symptoms of malnutrition, who probably cannot be adequately nourished enterally for a period of

Published
2009

49. Obesity in the critically ill: a narrative review

Author

Schetz, M., Jong, A. de, Deane, A.M., Druml, W., Hemelaar, P., Pelosi, P., Pickkers, P., Reintam-Blaser, A., Roberts, J., Sakr, Y., Jaber, S., Schetz, M., Jong, A. de, Deane, A.M., Druml, W., Hemelaar, P., Pelosi, P., Pickkers, P., Reintam-Blaser, A., Roberts, J., Sakr, Y., and Jaber, S.

Abstract

Item does not contain fulltext, The World Health Organization defines overweight and obesity as the condition where excess or abnormal fat accumulation increases risks to health. The prevalence of obesity is increasing worldwide and is around 20% in ICU patients. Adipose tissue is highly metabolically active, and especially visceral adipose tissue has a deleterious adipocyte secretory profile resulting in insulin resistance and a chronic low-grade inflammatory and procoagulant state. Obesity is strongly linked with chronic diseases such as type 2 diabetes, hypertension, cardiovascular diseases, dyslipidemia, non-alcoholic fatty liver disease, chronic kidney disease, obstructive sleep apnea and hypoventilation syndrome, mood disorders and physical disabilities. In hospitalized and ICU patients and in patients with chronic illnesses, a J-shaped relationship between BMI and mortality has been demonstrated, with overweight and moderate obesity being protective compared with a normal BMI or more severe obesity (the still debated and incompletely understood "obesity paradox"). Despite this protective effect regarding mortality, in the setting of critical illness morbidity is adversely affected with increased risk of respiratory and cardiovascular complications, requiring adapted management. Obesity is associated with increased risk of AKI and infection, may require adapted drug dosing and nutrition and is associated with diagnostic and logistic challenges. In addition, negative attitudes toward obese patients (the social stigma of obesity) affect both health care workers and patients.

Published
2019

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