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Purpose The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1–3) days vs. 3 (Q1-Q3, 1–6) days) and hospital length of stay (median 14 (Q1-Q3, 9–24) days vs. 10 (Q1-Q3, 7–17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07169-7.

Background/aim: Our aim in this study was to compare the efficacy and safety of crystalloid del Nido solution and cold blood cardioplegia solution on clinical and laboratory parameters. Materials and methods: Sixty patients who underwent elective coronary bypass operation between July 2019 and January 2020 were included in our study. Patients were divided into 2 groups of 30 patients using del Nido solution (DNS) and cold blood cardioplegia solution (CBCS), which were given for cardiac arrest. Demographic data, preoperative, postoperative 0th h, 6th h and 4th day creatine kinase myocardial band (CK-MB) and troponin I values were compared with a specific cardiac enzyme heart-type fatty acid-binding protein (H-FABP). Results: We found that aortic cross clamp duration and cardiopulmonary bypass (CPB) time were shorter in patients using del Nido solution than cold blood cardioplegia solution (57.30 ± 23.57 min, 76.07 ± 27.18 min, P = 0.006) (95.07 ± 23.06 min, 114.13 ± 33.93, P = 0.014). Total cardioplegia solution volume was higher in the cold blood cardioplegia solution group (1426.67 ± 416.00 vs. 1200 ± 310.73 P = 0.02). Preoperative and postoperative levels of cardiac enzymes including CK-MB, troponin I and H-FABP were comparable in del Nido solution and cold blood cardioplegia solution groups. Conclusion: According to these results, when we compare both demographic data and CK-MB, troponin I and H-FABP levels, both cardioplegia solutions were comparable regarding safety and efficacy in terms of myocardial protection.

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Objective:The aim of this study was to investigate the attitudes of patient relatives about organ donation for patients with brain death diagnosis and to identify the cause of negative attitudes related to donation.Methods: A retrospective examination was made of the archived records of patients with brain death (BD) diagnosis from September 2007 to August 2018 in Anesthesia Reanimation Intensive Care Unit. Demographic factors of the cases with BD such as age, gender, and admission diagnosis were recorded. The patient families were then contacted by telephone and organ donation acceptance or rejection was assessed in terms of reasons. Results:A total of 86 cases with brain death diagnosis were identified. When cases were assessed in terms of admission diagnoses, post-CPR hypoxic brain was the most common diagnosis (30.2%). The organ donation rate was identified as 12.8% (n=11). The mean age of patients was 31.09±20.98 years in those who donated organs, and 35.62±21.45 years in those whose families rejected donation (p=0.614). When the factors causing brain death of patients with organ donation were assessed, 54.4% died due to traumatic reasons. The two most important factors identified in the study for families rejecting organ donation were religious beliefs (41.3%) and beliefs about not disrupting the integrity of the body after death (37.3%). The most important factor for acceptance was the wish to help other people (91%). Conclusion:In our study, religious beliefs were found as the main reason for rejection of organ donation. To be able to increase cadaver-sourced donation rates, there is a need for society to be informed by religious leaders, family interviews should be held with an experienced and trained organ donation co-ordinator and families should definitely be fully informed about the sensitivity shown to bodily integrity during the organ donation procedure and surgical procedures.Amaç: Çalışmanın amacı beyin ölümü tanısı konulan hastaların yakınlarının organ bağışı ile ilgili tutumunu incelemek ve bağışla ilgili olumsuz tutumların nedenlerini tespit etmektir. Gereç ve Yöntemler:Retrospektif desende tasarlanan çalışma kapsamında, Eylül 2007 ve Ağustos 2018 tarihleri arasında Anestezi Yoğun Bakımda beyin ölümü tanısı alan hastaların arşiv kayıtları incelenmiş, beyin ölümü gerçekleşen hastaların yaş, cinsiyet, yatış tanıları gibi demografik özellikleri incelenmiştir. Hastaların ailelerine telefonla ulaşılmış, ailelerin organ nakli kabul ve ret nedenleri değerlendirilmiştir.Bulgular: Yapılan arşiv incelemesi sonucunda beyin ölümü tanısı konmuş olan 86 olgu tespit edilmiştir. Olgular yatış tanıları açısından değerlendirildiğinde post CPR hipoksik beyin'in en sık görülen tanı (%30.2) olduğu görülmüştür. Organ bağış oranının %12.8 (n=11) olduğu tespit edilmiştir. Organ bağışında bulunan hastaların ortalama yaşları 31.09±20.98, aileleri tarafından organ bağışında bulunulmayan hastaların yaş ortalamarı ise 35.62±21.45 olarak belirlenmiştir. Organ bağışı yapılan hastalarda beyinin ölümüne neden olan faktörler d...

Objective Our goal was to compare the operative and postoperative effects of del Nido cardioplegia (DN group) and blood cardioplegia (BC group) performed in cardiac surgery. Methods A total of 83 patients were included, separated into DN group and BC group. The operative and postoperative effects of the two groups were compared for the first 24 hours until extubation. The operative and postoperative complete blood count (CBC), biochemical values and clinical parameters were compared. Results The first control activated clotting time (ACT) levels in DN group patients were lower ( P =0.003) during the operation. The amount of cardioplegia in DN group were lower than that in BC group ( P =0.001). The pump outflow and postoperative lactate level of DN group were lower than those of BC group ( P =0.005, P =0.018, respectively), as well as the amounts of NaHCO3 ( P =0.006) and KCl ( P =0.001) used during the operation. The same occurred with the first monocytes (Mo) and mean corpuscular volume (MCV) levels in the postoperative intensive care unit ( P =0.006, P =0.002). However, the first glucose level and the eosinophil (Eo) level were higher in DN group ( P =0.011, P =0.047, respectively). Conclusion In the operative evaluation, the amount of cardioplegia, the first ACT levels, the pump outflow lactate level and the amounts of NaHCO 3 and KCl in DN group were lower. In postoperative evaluation, measured level of lactate, Mo and MCV in DN group were all lower; their glucose and Eo levels were higher.

Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. MethodsIn this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middleincome countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42•4% vs 44•2%; absolute difference -1•69 [-9•58 to 6•11] p=0•67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H 2 O; p=0•0011). ICU mortality was higher in MICs than in HICs (30•5% vs 19•9%; p=0•0004; adjusted effect 16•41% [95% CI 9•52-23•52]; p<0•0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0•80 [95% CI 0•75-0•86]; p<0•0001).Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status.