Descriptive study of differences in acute kidney injury progression patterns in General and Cardiac Intensive Care Units

Pachucki, Marcin; Ghosh, Erina; Eshelman, Larry J.; Palanisamy, Krishnamoorthy; Gould, T; Thomas, Matthew; Bourdeaux, Chris

doi:10.1177/1751143718771261

Cited by 3 publications

(5 citation statements)

References 15 publications

(25 reference statements)

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“…The median onset of AKI was day 1 in hemodynamically unstable patients and day 2 for hemodynamically stable group. This is in concordance with what was recently published that the highest incidence of AKI in ICU patients occurred between day 1 and day 2 of admission, when 28.4% had AKI (38).…”

Section: Discussionsupporting

confidence: 93%

Acute Kidney Injury In Children Admitted In Pediatric Intensive Care Unit

Elkazaz

Bazaraa

Salah

et al. 2022

Pediatric Sciences Journal

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Background: Acute kidney injury (AKI) poses a significant burden for the society, in terms of health resource use during the acute phase, and the potential long-term sequelae including development of chronic kidney disease and kidney failure. Aim of the work: to investigate the risk of development of AKI in critically ill children. Material and methods:A cohort study conducted on 60 critically ill children admitted at pediatric intensive care unit (PICU). They were divided into two groups according to hemodynamic stability. Cardiovascular parameters together with criteria for AKI were observed during the first 5 days of PICU admission. AKI was diagnosed based on Acute Kidney Injury Network criteria. Results: From all critically ill included patients (60 patients); thirty four patients developed AKI (56.6%). Frequency of AKI was significantly more in hemodynamically unstable than stable patients 22 (73%) versus 12 (40%) (p=0.018). AKI was strongly associated with decreased baseline systolic and diastolic blood pressure percentiles (p=0.04) and (p=0.049), increased doses and duration of inotropic support determined by vasoactive inotropic score (p=0.002) and (p=0.013) respectively, higher base deficit in baseline blood gases (p=0.002), multiple organ dysfunctions (p<0.001) and exposure to nephrotoxic agents (p=0.036). Conclusion: AKI is a common morbidity among hemodynamically unstable critically ill children. AKI is strongly associated with initial hypotension on admission, increased doses and longer duration of inotropic support, increased base deficit in initial blood gases evaluation, multiple organ dysfunctions and exposure to nephrotoxic agents.

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Section: Discussionsupporting

confidence: 93%

Acute Kidney Injury In Children Admitted In Pediatric Intensive Care Unit

Elkazaz

Bazaraa

Salah

et al. 2022

Pediatric Sciences Journal

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“…The GICU admits a broader population of emergency and elective medical and surgical patients. We reported in previous work that the pattern of AKI development in these populations is different [ 14 ]. It is likely that the precipitants of AKI are disparate between the 2 groups and therefore opportunities and strategies to intervene in AKI may vary.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous AKI scores were calculated for the control phase using electronic sniffer algorithm and have been previously described in a previous publication [ 14 ]. AKI scores were calculated anytime a new urine output or a new serum creatinine measurement was charted.…”

Section: Methodsmentioning

confidence: 99%

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Impact of a computerized decision support tool deployed in two intensive care units on acute kidney injury progression and guideline compliance: a prospective observational study

et al. 2020

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Background Acute kidney injury (AKI) affects a large proportion of the critically ill and is associated with worse patient outcomes. Early identification of AKI can lead to earlier initiation of supportive therapy and better management. In this study, we evaluate the impact of computerized AKI decision support tool integrated with the critical care clinical information system (CCIS) on patient outcomes. Specifically, we hypothesize that integration of AKI guidelines into CCIS will decrease the proportion of patients with Stage 1 AKI deteriorating into higher stages of AKI. Methods The study was conducted in two intensive care units (ICUs) at University Hospitals Bristol, UK, in a before (control) and after (intervention) format. The intervention consisted of the AKIN guidelines and AKI care bundle which included guidance for medication usage, AKI advisory and dashboard with AKI score. Clinical data and patient outcomes were collected from all patients admitted to the units. AKI stage was calculated using the Acute Kidney Injury Network (AKIN) guidelines. Maximum AKI stage per admission, change in AKI stage and other metrics were calculated for the cohort. Adherence to eGFR-based enoxaparin dosing guidelines was evaluated as a proxy for clinician awareness of AKI. Results Each phase of the study lasted a year, and a total of 5044 admissions were included for analysis with equal numbers of patients for the control and intervention stages. The proportion of patients worsening from Stage 1 AKI decreased from 42% (control) to 33.5% (intervention), p = 0.002. The proportion of incorrect enoxaparin doses decreased from 1.72% (control) to 0.6% (intervention), p < 0.001. The prevalence of any AKI decreased from 43.1% (control) to 37.5% (intervention), p < 0.05. Conclusions This observational study demonstrated a significant reduction in AKI progression from Stage 1 and a reduction in overall development of AKI. In addition, a reduction in incorrect enoxaparin dosing was also observed, indicating increased clinical awareness. This study demonstrates that AKI guidelines coupled with a newly designed AKI care bundle integrated into CCIS can impact patient outcomes positively.

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“…Since then we have continued to expand the capabilities of the dashboards to support clinical decision making and improve the quality of care. We have collaborated with Philips on the development of dashboard intervention for acute kidney injury 6, 7 and have begun to explore machine learning methods for the automatic classification of ward-dischargeable patients 8 .…”

Section: Introductionmentioning

confidence: 99%

Curation of an intensive care research dataset from routinely collected patient data in an NHS trust.

et al. 2019

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In this data note we provide the details of a research database of 4831 adult intensive care patients who were treated in the Bristol Royal Infirmary, UK between 2015 and 2019. The purposes of this publication are to describe the dataset for external researchers who may be interested in making use of it, and to detail the methods used to curate the dataset in order to help other intensive care units make secondary use of their routinely collected data. The curation involves linkage between two critical care datasets within our hospital and the accompanying code is available online. For reasons of data privacy the data cannot be shared without researchers obtaining appropriate ethical consents. In the future we hope to obtain a data sharing agreement in order to publicly share the de-identified data, and to link our data with other intensive care units who use a Philips clinical information system.

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Descriptive study of differences in acute kidney injury progression patterns in General and Cardiac Intensive Care Units

Cited by 3 publications

References 15 publications

Acute Kidney Injury In Children Admitted In Pediatric Intensive Care Unit

Acute Kidney Injury In Children Admitted In Pediatric Intensive Care Unit

Impact of a computerized decision support tool deployed in two intensive care units on acute kidney injury progression and guideline compliance: a prospective observational study

Curation of an intensive care research dataset from routinely collected patient data in an NHS trust.

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