Protocol of the comparison of two different bicarbonate replacement fluids during CVVH with RCA: a Prospective, Randomized, Controlled Trial.

Background: Acid-base disturbances are common issues during continuous veno-venous hemofiltration (CVVH). Especially using regional citrate anticoagulation (RCA) recent studies have shown that control in intracorporal pH and HCO3- concentration may be improved when the replacement fluid is changed to a solution with a lower HCO3- concentration during continuous renal replacement therapy (CRRT). This prospective trail aims to compare acid base balance between a high (HBF) and low (LBF) bicarbonate replacement fluid over a period of 96 hours after CVVH initiation using RCA.

Soluble Neuropilin-1 as a Marker for Distinguishing Bacterial and Viral Sepsis in Critically Ill Patients-A Prospective, Multicenter, Observational Study.

Sepsis causes millions of deaths each year. Rapid, targeted therapy can reduce mortality rates. Both bacterial and viral pathogens can trigger sepsis, but the utility of commonly used inflammatory markers for differentiation remains controversial.

State of the art: Renal recovery after AKI - from basic science to clinical practice.

Purpose: Acute kidney injury (AKI) is common in critically ill patients and associated with a high risk of mortality, chronic kidney disease (CKD) and cardiovascular morbidity. The risks are higher in patients with incomplete or no renal recovery. The purpose of this review is to summarize the current understanding of the mechanisms of renal recovery, list some key risk factors for nonrecovery and highlight knowledge gaps.

Prognosis of Nonagenarian ICU Patients A Bayesian analysis of prospective European studies.

Background: As the population ages, the number of very elderly patients (≥ 90 years, nonagenarians) admitted to intensive care units (ICUs) is increasing. This trend raises concerns about the appropriateness of ICU care for this age group, especially due to the uncertainty surrounding their prognosis. Some studies suggest that elderly ICU patients have outcomes similar to slightly younger patients, but skepticism remains due to clinical judgment, cultural attitudes, and resource allocation concerns.

[S3 guideline on renal replacement therapy in intensive care medicine : Evidence-based implementation of renal replacement therapy in critically ill patients].

Besides mechanical ventilation, renal replacement therapy is the most frequently performed organ replacement therapy in intensive care medicine. However, there is a lack of consensus- and evidence-based recommendations for the implementation of renal replacement therapy according to the best current knowledge and evidence. This guideline describes the topics of starting a renal replacement therapy, modality (diffusion or convection, continuous or intermittent procedures), anticoagulation, adequate dose, and criteria for stopping renal replacement therapy.

High bicarbonate replacement fluid and time to pH normalization during continuous veno-venous hemofiltration with regional citrate anticoagulation: a retrospective single-center cohort study.

Background: In critically ill patients, acid-base disorders are common before start of continuous renal replacement therapy. The aim of this study was to determine the influence of a high bicarbonate replacement fluid (30 mmol/L, Phoxilium) on underlying acid-base disturbances.

Methods: This single-center retrospective study included patients treated with continuous veno-venous hemofiltration (CVVH) at a medical ICU from January 2018 to May 2019.

The common genetic variant rs1278960 determining expression of Interferon-lambda predicts inflammatory response in critically ill COVID-19 patients.

The single nucleotide polymorphism rs12979860 is associated with the production of IFNλ4, a type III interferon, which offers protection from viral infection via its proinflammatory properties. We investigated if a genetically determined increase in IFNλ4 affects disease progression in SARS-CoV-2. This prospective, single-center study involved critically ill SARS-CoV-2 patients admitted to the intensive care unit.

[Vasoactive agents in septic shock-individualized strategies].

Hemodynamic stabilization and preservation of organ perfusion are central elements in the management of septic shock. This is achieved by fluid resuscitation and by administration of vasoactive agents. Current guidelines recommend norepinephrine as the first-line vasoactive substance.

Dialysis Dependence in Standard versus Accelerated Initiation of KRT in AKI: A Post Hoc Analysis.

Key Points: The Standard versus Accelerated Initiation of Renal Replacement Therapy in AKI trial found that starting dialysis earlier for AKI resulted in a 74% higher risk of still receiving dialysis at 90 days. Among patients who likely would have started dialysis under usual practice, the risks of dialysis dependence were similar. This suggests much of the risk observed may have been due to starting dialysis (versus never starting) rather than starting slightly earlier.

Renal replacement therapy modalities and techniques in intensive care units: An international survey.

Background And Hypothesis: Up to 14 % of critically ill patients receive renal replacement therapy (RRT) during their ICU stay and are treated with intermittent hemodialysis (IHD) or one of the continuous renal replacement therapy (CRRT) techniques. The choice of a modality (IHD or CRRT) and technique (continuuous veno-venous -hemodialysis (CVVHD), -hemofiltration (CVVH), or - hemodiafiltration (CVVHDF)), and the way it is delivered, may have an impact on outcomes but only few studies addressed this question. We aimed to survey the availability, settings, and clinicians' preferences regarding RRT modalities and techniques in critically ill patients.

Time to Renal Replacement Therapy Initiation in Critically Ill Patients With Acute Kidney Injury: A Secondary Analysis of the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial.

Objectives: Among critically ill patients with severe acute kidney injury (AKI) who lack emergent indications for renal replacement therapy (RRT), a strategy of preemptive RRT initiation does not lead to improved outcomes. However, for patients with persistent AKI and without urgent indications for RRT, the safety of prolonged delays in RRT initiation is unclear. We sought to assess the association between progressively longer delays in RRT initiation and clinical outcomes.

Impact of mechanical ventilation on severe acute kidney injury in critically ill patients with and without COVID-19 - a multicentre propensity matched analysis.

Background: Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Its complications often require renal replacement therapy (RRT). Invasive mechanical ventilation (IMV) and infections are considered risk factors for the occurrence of AKI.

Acute kidney injury.

Acute kidney injury (AKI) is a common, heterogeneous, multifactorial condition, which is part of the overarching syndrome of acute kidney diseases and disorders. This condition's incidence highest in low-income and middle-income countries. In the short term, AKI is associated with increased mortality, an increased risk of complications, extended stays in hospital, and high health-care costs.

Contemporary assessment of short- and functional 90-days outcome in old intensive care patients suffering from COVID-19.

Purpose: There are limited data about the outcome of old intensive care (ICU) patients suffering from Covid-19 in the post-vaccination era. This study distinguishes the pre- and post-acute illness living conditions of ICU survivors from non-survivors.

Methods: This prospective international multicenter study included 642 old (≥ 70 years) ICU patients, including data ranging from pre-illness condition to functional 90-days follow-up.

Acute kidney injury subphenotyping and personalized medicine.

Purpose Of Review: This review discusses novel concepts of acute kidney injury (AKI), including subphenotyping, which may facilitate the development of target treatment strategies for specific subgroups of patients to achieve precision medicine.

Recent Findings: AKI is a multifaceted syndrome with a major impact on morbidity and mortality. As efforts to identify treatment strategies have largely failed, it is becoming increasingly apparent that there are different subphenotypes that require different treatment strategies.

Effect of therapeutic plasma exchange on tissue factor and tissue factor pathway inhibitor in septic shock.

Background: Coagulopathy is part of the pathological host response to infection in sepsis. Higher plasma concentrations of both tissue factor (TF) and tissue factor pathway inhibitor (TFPI) are associated with occurrence of disseminated intravascular coagulation (DIC), multi-organ dysfunction and increased mortality in patients with sepsis. Currently no treatment approaches specifically targeting this axis are available.