Ethics and End-of-Life Care Jozef Kesecioglu Journal of Translational Critical Care Medicine 2019 1(2):45-47

Pragmatic Studies for Acute Kidney Injury in China: Renal Replacement Therapy for Acute Kidney Injury and Sepsis Consensus Report of Acute Disease Quality Initiative XIX John R Prowle, Bin Du, Changsong Wang, Martin Gallagher Journal of Translational Critical Care Medicine 2019 1(2):48-51 In this article, we report consensus of 19th Acute Disease Quality Initiative (ADQI) conference and pragmatic trial proposals on renal replacement therapy (RRT) for acute kidney injury (AKI)and sepsis. The committee develop a list of key questions for the pragmatic trials. Then a systematic literature search was performed using PubMed and Embase. Finally the group summarized the proposed trials using PICO(Patient, Intervention, Comparator, Outcome). The groups recommended the first step would be a prospective observational study to document the current clinical practice of RRT in ICUs. Then the second stage would be to develop a quality improvement (QI) tools to improve and standardize the RRT practice in ICUs. The committee also proposed the primary outcome and secondary outcomes of the trial. Consensus had been reached for the pragmatic trial of RRT for AKI and sepsis in Chinese ICUs.

Pragmatic Studies for Acute Kidney Injury: Fluid Resuscitation in the Peri-Acute Kidney Injury Period Raghavan Murugan, Haibo Qiu, Thomas Rimmele, Jianguo Li, Zhiyong Peng, Kaijiang Yu, John A Kellum, Claudio Ronco Journal of Translational Critical Care Medicine 2019 1(2):52-56 How fluid resuscitation clinical trials should be conducted for either prevention or treatment of acute kidney injury among patients admitted to the intensive care unit is unclear. In 2017, a group of experts in fluid resuscitation and acute kidney injury met at the Acute Disease Quality Initiative (ADQI) XIX consensus conference on “Pragmatic Studies for AKI”, Wuhan, China and developed a research framework. In this report, we summarize the consensus recommendations on the topic of fluid resuscitation in the peri-AKI period based on existing clinical evidence. We also discuss the gaps in our knowledge and identify future research questions. Finally, we examine the feasibility of conducting a pragmatic fluid resuscitation trial to improve outcomes from acute kidney injury.

Is there a Role for Systematic Tools to Improve the Clinical Management of Patients with Acute Kidney Injury? Consensus Report of Acute Disease Quality Initiative XIX Marlies Ostermann, Xiumin Xi, Jean-Louis Vincent, Raymond K Hsu Journal of Translational Critical Care Medicine 2019 1(2):57-60 Acute kidney injury (AKI) occurs in approximately 20% of hospitalized patients and is associated with increased morbidity and mortality. The care of hospitalized patients with AKI has been shown to be variable in clinical practices. Systematic tools including checklists, care bundles and medical algorithms have been developed and implemented to improve the care and outcomes of AKI patients. However, whether these systematic tools can improve the quality of care and outcomes of AKI patients is still unknown. The committee of the 19th Acute Disease Quality Initiative (ADQI) conference dedicated a workgroup with the task of developing a study protocol to investigate this question. A comprehensive literature search was performed using PubMed and Embase. Key questions and feasibility of potential study proposals were discussed during the conference. Then a two-step Delphi process was used to reach consensus regarding several aspects of the study protocol. The group suggested that patient risk assessment be included in the study protocol and the choice of systematic tool be depending on different clinical contexts. The group also proposed a two-phase study with the use of oliguria and systematic tool to investigate the quality of care and outcomes of AKI patients. Consensus was reached on a study protocol regarding the efficacy of using systematic tools to improve clinical management and outcomes of AKI patients.

The Intensity of Renal Replacement Treatment for Acute Kidney Injury: A Systematic Review and Network Meta-Analysis Hongliang Wang, Haitao Liu, Yue Wang, Hongshuang Tong, Pulin Yu, Shuangshuang Chen, Guiyue Wang, Miao Liu, Yuhang Li, Nana Guo, Changsong Wang, Kaijiang Yu Journal of Translational Critical Care Medicine 2019 1(2):61-68 Background: Acute kidney injury (AKI) is a common and serious complication in critically ill patients. Patients who require renal replacement therapy (RRT) face a high mortality rate. Questions concerning the intensity of RRT in AKI patients led us to integrate direct and indirect evidence using a network meta-analysis to determine the optimal intensity and mode. Materials and Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science databases from 1990 to 2017 that included randomized controlled trials (RCTs) comparing different intensities of RRT to treat AKI in adults (18 years or older). Data regarding study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used the GeMTC package in R to combine direct comparisons with indirect evidence. Results: Ten RCTs including 3354 participants were included in the network meta-analysis. The higher intensity continuous renal replacement treatment (CRRT) (to exceed 35 mL/kg/h) and the higher intensity IRRT (to exceed six times per week) both showed no statistical significance. Further analysis for higher intensity CRRT, lower intensity CRRT, higher intensity IRRT, and lower intensity IRRT also revealed no significance. Conclusions: This meta-analysis showed that increasing the intensity of CRRT to exceed 35 mL/kg/h and six times per week for intermittent RRT (IRRT) did not reduce mortality or the rate of dependence on dialysis among AKI patients.

Management of Simultaneously Occurring Multiple Massive Intracerebral Hemorrhages Luis Rafael Moscote-Salazar, Tariq Janjua, Amit Agrawal, Guru Dutta Satyarthee, Willem Guillermo Calderon-Miranda Journal of Translational Critical Care Medicine 2019 1(2):69-71 Occurrence of simultaneous multiple intracerebral hemorrhages (ICHs) in different arterial territories is an uncommon presentation. We report the cases of concurrent ocular and ICHs. The rarity of these lesions leads to delay in the diagnosis. Further lack of clear management guidelines for these pathologies makes further delay in the institution of appropriate therapy. In addition, the pathogenesis, diagnosis, and management along with pertinent literature are also reviewed.

Rose and Life: Anaphylaxis Following Rose-Thorn Prick Injury Neeraj Kumar, Amarjeet Kumar, Sanjeev Kumar Journal of Translational Critical Care Medicine 2019 1(2):72-74 We report a case of rose-thorn prick injury in a 60-year-old woman. She presented within hours of exposure to rose-thorn prick and after ruling out all other possible reasons of anaphylaxis. We initiated conservative mode of treatment with moist oxygen inhalation through face mask, nebulized adrenalin, intravenous corticosteroids, antihistaminic, and fluid resuscitation. She was immediately shifted to the intensive care unit in view of any airway obstruction and further hemodynamic monitoring. To the best of our knowledge, this is the first reported case of anaphylactic shock caused by rose-thorn injuries. Hence, to combat these life-threatening situations, proper education and training are given to healthcare personnel's and preparation of pre-filled adrenaline syringes for auto-injection should be kept ready in such places, especially in resuscitation areas.