The goals of this prospective study were to: 1) determine whether the pRIFLE criteria serve to characterize patterns of AKI in critically ill pediatric patients in a Level 1 PICU 2) determine the prevalence, demographic, and clinical characteristics of AKI in our cohort 3) establish the association between fluid overload, AKI, and mortality in our population and 4) identify whether pRIFLE scoring can predict morbidity (hospital and PICU length of stay) and mortality in our patients.Ī prospective analysis of patients admitted to a multidisciplinary, academic, tertiary care PICU in San Juan, Puerto Rico, between November 2009 and November 2010, was performed. Most studies are retrospective, and in patients with very high morbidity and mortality (mechanical ventilation, inotropes, post-transplant, post-cardiovascular surgery) 8. However, there are very few prospective studies that assess risk factors for AKI, fluid overload, and the utility of the pRIFLE criteria for identifying AKI in a general pediatric intensive care population. Higher FO% has been associated with higher mortality in patients receiving continuous renal replacement therapy, with higher oxygenation index, and longer length of stay 10, 11, 12, 13. 10, 11 Fluid overload (FO%), defined as: × 100], has been found to be an important predictive factor in critically ill children. *Calculated with Schwartz equation: Length (cm) × K (constant) / serum creatinineįluid overload is emerging as an important marker of morbidity and mortality in critically ill patients, especially in patients requiring continuous renal replacement therapy. No other risk factors such as nephrotoxins or fluid overload, were evaluated in this study. Plotz et al described a smaller retrospective cohort that identified AKI diagnosed by pRIFLE to be associated with higher mortality 9. The mortality of these patients was 14.6%, compared to 11.1% for those with normal renal function. In their cohort, 82% of 150 mechanically ventilated pediatric patients developed AKI as diagnosed by pRIFLE, and they did so predominantly within the first week of admission to the Pediatric Intensive Care Unit (PICU). Their proposed pRIFLE criteria are based on a decrease in estimated creatinine clearance (eCCl) and in urine output (Uop) based on weight. 4, 8 Recently, Ackan-Arikan et al developed a modified version of the RIFLE criteria for pediatric patients, called pRIFLE, shown in Table 1. Prospective pediatric studies of AKI are limited. The RIFLE criteria have been adopted by most intensive care units and nephrology societies as a way to define AKI, and they have been shown to independently predict hospital length of stay, healthcare costs, morbidity, and mortality in adult and pediatric patients 4, 5, 6, 7. 2 RIFLE (acronym for Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage Renal Disease) stratifies patients based on changes in serum creatinine (Scr) levels from baseline and/or a decrease in urine output (Uop) 3. 1, 2, Through this workgroup, the term Acute Kidney Injury (AKI) was introduced, and a new classification system, termed the RIFLE criteria, was proposed for use in critically ill adult patients. Recognizing the need for a more uniform definition, the Acute Dialysis Quality Initiative Group, consisting of specialists in adult and pediatric nephrology and critical care, established a system allowing for the classification of acute renal failure severity. Acute renal failure is a frequent clinical complication in critical care that is constituted by an acute drop in renal function, with manifestations ranging from minimal elevation of serum creatinine concentration, to anuric renal failure.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |