IntroductionPositive fluid balance has been associated with an increased risk for mortality in critically ill patients with acute kidney injury with or without renal replacement therapy (RRT). Data on fluid accumulation prior to RRT initiation and mortality are limited. We aimed to study the association between fluid accumulation at RRT initiation and 90-day mortality.MethodsWe conducted a prospective, multicenter, observational cohort study in 17 Finnish intensive care units (ICUs) during a five-month period. We collected data on patient characteristics, RRT timing, and parameters at RRT initiation. We studied the association of parameters at RRT initiation, including fluid overload (defined as cumulative fluid accumulation > 10% of baseline weight) with 90-day mortality.ResultsWe included 296 RRT-treated critically ill patients. Of 283 patients with complete data on fluid balance, 76 (26.9%) patients had fluid overload. The median (interquartile range) time from ICU admission to RRT initiation was 14 (3.3 to 41.5) hours. The 90-day mortality rate of the whole cohort was 116 of 296 (39.2%; 95% confidence interval 38.6 to 39.8%). The crude 90-day mortality of patients with or without fluid overload was 45 of 76 (59.2%) vs. 65 of 207 (31.4%), P < 0.001. In logistic regression, fluid overload was associated with an increased risk for 90-day mortality (odds ratio 2.6) after adjusting for disease severity, time of RRT initiation, initial RRT modality, and sepsis. Of the 168 survivors with data on RRT use at 90 days, 34 (18.9%, 95% CI 13.2 to 24.6%) were still dependent on RRT.ConclusionsPatients with fluid overload at RRT initiation had twice as high crude 90-day mortality compared to those without. Fluid overload was associated with increased risk for 90-day mortality even after adjustments.

The incidence of JET was 5.0% in this large paediatric open-heart surgery patient group. Compared with controls, these patients had longer cardiopulmonary bypass time and higher level of troponin-T, possibly reflecting the extent of surgical trauma. However, the tachycardia was not an independent risk factor for death.

In children with univentricular heart, intellectual and neurologic deficits are common. Perioperative and postoperative risk factors related to the primary phase and bidirectional Glenn operation contribute to these deficits.

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At age 1 year, the level of development of children with univentricular heart was significantly lower than for control subjects only in motor skills, whereas children with hypoplastic left heart syndrome had a more widespread developmental delay. The diagnosis, a clinical seizure history, and increased plasma lactate levels after the bidirectional Glenn operation emerged as risk factors.

SummaryThe time course of changes in breathing pattern in opioid-induced respiratory depression was characterised for two opioids. Intravenous morphine (0.039 mg.kg À1 bolus 0.215 mg.kg À1 .h À1 infusion) and oxycodone (0.05 mg.kg À1 bolus 0.275 mg.kg À1 .h À1 infusion) were administered to six healthy male volunteers for 2 h in a random, double-blind and cross-over fashion. Monitoring included pulse oximetry and noninvasive respiratory-inductive plethysmography for the measurement of breathing pattern. The total amounts of drugs given were 35.1 (0.0) mg [mean (SD)] morphine and 41.3 (8.0) mg oxycodone. Four of the six oxycodone infusions had to be stopped at 99 (14) min because of respiratory depression as judged by pulse oximetry. No morphine infusions were stopped. The ®rst changes in breathing pattern were a decrease in respiratory rate and an increase in the contribution of the rib cage to tidal volume, while the compensatory increase in tidal volume became evident later. A decrease in minute ventilation and inspiratory duty cycle were also found. Opioids are known to decrease both hypoxic and hypercapnic respiratory drive [1]. However, little is known about opioid-induced changes in breathing pattern. The aim of this study was to describe the time, dose and concentration dependence of changes in breathing pattern for two m-agonist opioids, morphine and oxycodone and, if possible, to ®nd an ideal parameter for detecting early respiratory depression. MethodsSix healthy male volunteers, aged 21±30 years and weighing 68±80 kg, participated in this double-blind, randomized cross-over study. The subjects were non-smokers and had no medication or history of drug or alcohol abuse. The study protocol was approved by the Institutional Ethics Committee of Turku University Hospital and written informed consent was obtained from all participants. The subjects participated in two study sessions at least 10 days apart. After fasting for at least 12 h (only a glass of juice was allowed), the volunteers were admitted to the laboratory. The radial artery and an antecubital vein were cannulated. In the second session, the radial artery of the contralateral hand was used. After attaching the sensor bands of the respiratory-inductive plethysmograph, breathing and haemodynamics were allowed to settle over 20 min in the supine position before baseline measurements were taken.The drugs were diluted with saline to 50 ml by an independent anaesthetist. An intravenous bolus dose of oxycodone (Oxanest 10 mg.ml À1 , Leiras, Finland) 0.05 mg.kg À1 or morphine (Morphin 20 mg.ml À1 , Leiras, Finland) 0.039 mg.kg À1 was given in 1 min followed by an infusion of 0.275 mg.kg À1 .h À1 or 0.215 mg.kg À1 .h À1 , respectively lasting 115 min. If arterial oxygenation was seriously impaired, determined by an oxygen saturation under 90% over 30 s, the infusion was stopped. After stopping the infusion, the measurements were continued for 60 min, after which naloxone 0.8 mg was given.