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- Rimes-Stigare, C, et al.
(författare)
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Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors
- 2018
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Ingår i: Critical care research and practice. - : Hindawi Limited. - 2090-1305 .- 2090-1313. ; 2018, s. 7698090-
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Tidskriftsartikel (refereegranskat)abstract
- Background. Renal dysfunction after acute kidney injury (AKI) is common, potentially modifiable, but poorly understood. Acute kidney disease (AKD) describes renal dysfunction 7 to 90 days after AKI and is determined by percentage change in creatinine from baseline. Chronic kidney disease (CKD) is defined as the estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 persisting for more than 90 days. We compared CKD incidence using both creatinine- and cystatin C-based GFR with AKD incidence at 90 days in AKI survivors. Methods. A prospective cohort study was conducted in a Swedish intensive care unit (ICU) between 2008 and 2010. We included AKI patients alive at 90 days. We excluded patients <18 and >100 years, death before follow-up, CKD prior to admission, and follow-up before 60 days or beyond 270 days. Creatinine and cystatin C were measured at 90 days and converted to eGFR (mL/min/1.73 m2). Results. We included 274 patients. At 90-day follow-up, the median creatinine eGFR (MDRD) was 81.6 (IQR 58.6–106.8) and median cystatin C eGFR was 51.5 (IQR 35.8–70.7). The incidence of CKD (eGFR < 60) was 25.8% based on creatinine but 63.7% using cystatin C estimates. AKD was present in 47 patients (18.9%). Age, discharge cystatin C, creatinine at discharge, and female gender predicted creatinine-defined CKD at follow-up. Age, discharge cystatin C, CRRT on ICU, and diabetes were associated with cystatin C-based CKD. Conclusions. In AKI survivors followed up at 3 months, CKD criteria were met in a quarter of patients using creatinine and in two-thirds using cystatin C eGFR. Less than one-fifth of patients fulfilled AKD criteria. The application of AKD criteria may underestimate renal dysfunction in AKI survivors.
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- Tegnestedt, Charlotta, et al.
(författare)
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Levels and sources of sound in the intensive care unit : an observational study of three room types
- 2013
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 57:8, s. 1041-1050
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMany intensive care unit (ICU) patients describe noise as stressful and precluding sleep. No previous study in the adult setting has investigated whether room size impacts sound levels or the frequency of disruptive sounds.MethodsA-frequency S-time weighted equivalent continuous sound (LASeq), A-frequency S-time weighted maximum sound level (LASmax) and decibel C peak sound pressure (LCpeak) were measured during five 24-h periods in each of the following settings: three-bed room with nursing station (NS) alcove, single-bed room with NS alcove (1-BR with NSA) and single-bed room with bedside NS. Cumulative restorative time (CRT) (> 5 min with LASmax < 55 dB and LCpeak < 75 dB) was calculated to describe calm periods. Two 8-h bedside observations were performed in each setting in order to note the frequency and sources of disruptive sounds.ResultsMean sound pressure levels (LASeq) ranged between 52 and 58 dBA, being lowest during night shifts. There were no statistically significant differences between the room types in mean sound levels or in CRT. However, disruptive sounds were 40% less frequent in the 1-BR with NSA than in the other settings. Sixty-four percent of disruptive sounds were caused by monitor alarms and conversations not related to patient care.ConclusionsSingle-bed rooms do not guarantee lower sound levels per se but may imply less frequent disruptive sounds. Sixty-four percent of disruptive sounds were avoidable. Our findings warrant sound reducing strategies for ICU patients.
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