Management of Crush-Related Injuries after Disasters

Sever, Mehmet Şükrü; Vanholder, Raymond; Lameire, Norbert

doi:10.1056/nejmra054329

Cited by 272 publications

(196 citation statements)

References 62 publications

Supporting

Mentioning

187

Contrasting

Unclassified

Order By: Relevance

“…Initially, this is achieved primarily with isotonic crystalloid solutions 10-15 mLÁkg -1Á hr -1 titrated to physiologic endpoints such as central venous pressure and urine output (target 200-300 mLÁhr -1 for persisting myoglobinuria). 94 In the context of crush syndrome associated with disaster, fluid resuscitation should be initiated prior to evacuation. 89,95 Following initial resuscitation, bicarbonate 50-100 mEqÁL -1 can be added when titrated to achieve a urine pH [ 6.5 to increase the solubility and renal excretion of tubular myoglobin and uric acid casts and to attenuate concomitant acidosis, hyperkalemia, and release of free iron from myoglobin.…”

Section: Rhabdomyolysis and Myoglobinuric Akimentioning

confidence: 99%

See 1 more Smart Citation

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

show abstract

Section: Rhabdomyolysis and Myoglobinuric Akimentioning

confidence: 99%

“…However, all of the strategies lack robust data to support recommendation. 89,94 Unfortunately, no specific therapy is available in patients with myoglobinuria and overt kidney failure, and patients should be supported early by initiation of RRT.…”

Section: Rhabdomyolysis and Myoglobinuric Akimentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…In earthquakes, crush injuries can necessitate amputations and a bad fall can lead to permanent damage to the spine. Moreover, crush syndrome can cause kidney or heart failure (Sever 2006). However, the number of cases is small relative to the overall total numbers of injuries.…”

Section: Disability Resulting From Disastermentioning

confidence: 99%

Disability and Disaster: An Overview

Alexander¹

2015

Disability and Disaster

View full text Add to dashboard Cite

In most countries, people with disabilities make up between 10 and 20 per cent of the population, depending on how disability is classified and registered (WHO (2011) statistics give 7-10 per cent of the world's population as having disabilities, but it is likely that many remain uncounted, especially among the elderly). In emergencies, people with disabilities may encounter physical barriers, obstacles to communication and other barriers to accessing essential services (Figure 1). Hence, they may easily suffer greater discrimination, as well as lower levels of protection against disaster, than those offered to people without disabilities.The predicament of people with disabilities in disaster has been graphically described by This chapter considers the wide range of types of disability in the context of disaster.

show abstract

“…Furthermore, in isolated areas or major disasters, PD is technically simple with fewer infrastructural requirements, such as electricity and municipal water supply (9). In young children for whom vascular access is problematic, PD is often used.…”

Section: Introductionmentioning

confidence: 99%

Use of Peritoneal Dialysis in AKI

Chionh

Soni

Finkelstein

et al. 2013

Clinical Journal of the American Society of Nephrology

165

117

View full text Add to dashboard Cite

SummaryBackground and objectives The role of peritoneal dialysis in the management of AKI is not well defined, although it remains frequently used, especially in low-resource settings. A systematic review was performed to describe outcomes in AKI treated with peritoneal dialysis and compare peritoneal dialysis with extracorporeal blood purification, such as continuous or intermittent hemodialysis.Design, setting, participants, & measurements MEDLINE, CINAHL, and Central Register of Controlled Trials were searched in July of 2012. Eligible studies selected were observational cohort or randomized adult population studies on peritoneal dialysis in the setting of AKI. The primary outcome of interest was all-cause mortality. Summary estimates of odds ratio were obtained using a random effects model. ResultsOf 982 citations, 24 studies (n=1556 patients) were identified. The overall methodological quality was low. Thirteen studies described patients (n=597) treated with peritoneal dialysis only; pooled mortality was 39.3%. In 11 studies (7 cohort studies and 4 randomized trials), patients received peritoneal dialysis (n=392, pooled mortality=58.0%) or extracorporeal blood purification (n=567, pooled mortality=56.1%). In the cohort studies, there was no difference in mortality between peritoneal dialysis and extracorporeal blood purification (odds ratio, 0.96; 95% confidence interval, 0.53 to 1.71). In four randomized trials, there was also no difference in mortality (odds ratio, 1.50; 95% confidence interval, 0.46 to 4.86); however, heterogeneity was significant (I 2 =73%, P=0.03).Conclusions There is currently no evidence to suggest significant differences in mortality between peritoneal dialysis and extracorporeal blood purification in AKI. There is a need for good-quality evidence in this important area.

show abstract

Management of Crush-Related Injuries after Disasters

Cited by 272 publications

References 62 publications

Review article: Acute kidney injury in critical illness

Review article: Acute kidney injury in critical illness

Disability and Disaster: An Overview

Use of Peritoneal Dialysis in AKI

Contact Info

Product

Resources

About