The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
J Iglesias - One of the best experts on this subject based on the ideXlab platform.
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low dose dopamine does not prevent acute renal failure in patients with septic shock and Oliguria norasept ii study investigators
The American Journal of Medicine, 1999Co-Authors: Paul E Marik, J IglesiasAbstract:Editorial Comment: The authors evaluated a subset of patients enrolled in a large multiinstitutional study who had septic shock and were in an intensive care unit. Although there was no prospective randomization, 395 patients who had Oliguria were retrospectively analyzed and divided into 3 groups of those who received less than 3 mg./kg. dopamine per minute, greater than 3 mg./kg. dopamine per minute and no dopamine. The authors found that there was absolutely no difference in the incidence of acute renal failure, the need for dialysis or 28-day survival among the 3 groups. About a third of all patients actually progressed to have acute renal failure and about a half of them required dialysis or ultrafiltration. Although it has significant flaws due to the lack of randomization, this study strongly supports the contention that there is no good evidence that low dose dopamine has any affect on preventing acute renal failure in patients with Oliguria secondary to sepsis. W. Scott McDougal, M.D.
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low dose dopamine does not prevent acute renal failure in patients with septic shock and Oliguria
The American Journal of Medicine, 1999Co-Authors: Paul E Marik, J IglesiasAbstract:Acute renal failure is a common and serious complication in critically ill hospitalized patients. Indeed, the mortality of acute renal failure in patients treated in intensive care units has remained greater than 50%, despite improvements in renal replacement therapy and aggressive supportive care (1, 2). As low-dose dopamine (0.5 to 3 mg/kg/minute) may have several potential benefits for patients with Oliguria or established acute renal failure, it has become the standard of care for preventing or ameliorating acute renal failure. However, low-dose dopamine has not been demonstrated to improve the outcome of these patients. Furthermore, the widespread use of low-dose dopamine continues despite editorials and reviews urging its discontinuation because of its lack of efficacy and potential toxicity (3–12). Among the 1,879 patients with septic shock who were treated with placebo in the NORASEPT II study (a multicenter, randomized, double-blind trial comparing the administration of monoclonal antibody to human tumor necrosis factor-a with placebo), 395 patients had Oliguria at the time of randomization (13). The nonrandomized use of low-dose dopamine with these patients provided the opportunity to evaluate the effects of its use on the development of acute renal failure.
Taliang Chen - One of the best experts on this subject based on the ideXlab platform.
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change of blood pressure and urine flow rate during cardiopulmonary bypass and its relation to postoperative renal function
Journal of the Formosan Medical Association, 1994Co-Authors: M J Wang, Taliang ChenAbstract:: The relationship between the perfusion flow, the mean arterial pressure (MAP) and the urine flow rate during cardiopulmonary bypass (CPB) and the effect of Oliguria developed during CPB on the postoperative renal dysfunction were studied prospectively in 69 open heart surgery patients. The MAP, the perfusion flow and the urine flow rate were monitored every five minutes during the first 45 minutes after the commencement of CPB and after the removal of the aortic cross clamp (AX). The serum creatinine (Cr), creatinine clearance (CCr) and blood urea nitrogen were measured before operation, as well as on the first, second and third postoperative days. The dosage of catecholamines and diuretics used and the duration of intubation and hospitalization in the intensive care unit were also recorded. The urine flow rate correlated with MAP much better than the perfusion flow during CPB (r = 0.4768, p < 0.0001). The urine flow rate and MAP decreased significantly after the initiation of CPB and after the release of the AX; however, Oliguria developed only during the first 30 minutes of CPB. There were no differences in postoperative Cr, postoperative CCr, doses of catecholamines or diuretics, and the duration of intubation between patients with or without development of Oliguria during CPB. Parameters measured during CPB could not predict CCr during the first three postoperative days. We conclude that it is MAP rather than perfusion flow which correlates with the urine flow rate during CPB. Periods of Oliguria during CPB did not correlate with or help in the prediction of the development of postoperative renal dysfunction.
Mohamud Egal - One of the best experts on this subject based on the ideXlab platform.
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targeting Oliguria reversal in perioperative restrictive fluid management does not influence the occurrence of renal dysfunction a systematic review and meta analysis
European Journal of Anaesthesiology, 2016Co-Authors: Mohamud Egal, Hilde R H De Geus, Jaspe Van Bommel, A Joha GroeneveldAbstract:BACKGROUNDInterest in perioperative fluid restriction has increased, but it could lead to hypovolaemia. Urine output is viewed as a surrogate for renal perfusion and is frequently used to guide perioperative fluid therapy. However, the rationale behind targeting Oliguria reversal – achieving and mai
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targeting Oliguria reversal in goal directed hemodynamic management does not reduce renal dysfunction in perioperative and critically ill patients a systematic review and meta analysis
Anesthesia & Analgesia, 2016Co-Authors: Mohamud Egal, Nicole S Erler, Hilde R H De Geus, Jasper Van Bommel, A Johan B GroeneveldAbstract:BACKGROUND: We investigated whether resuscitation protocols to achieve and maintain urine output above a predefined threshold-including Oliguria reversal as a target-prevent acute renal failure (ARF). METHODS: We performed a systematic review and meta-analysis using studies found by searching MEDLINE, EMBASE, and references in relevant reviews and articles. We included all studies that compared "conventional fluid management" (CFM) with "goal-directed therapy" (GDT) using cardiac output, urine output, or oxygen delivery parameters and reported the occurrence of ARF in critically ill or surgical patients. We divided studies into groups with and without Oliguria reversal as a target for hemodynamic optimization. We calculated the combined odds ratio (OR) and 95% confidence intervals (CIs) using random-effects meta-analysis. RESULTS: We based our analyses on 28 studies. In the overall analysis, GDT resulted in less ARF than CFM (OR, 0.58; 95% CI, 0.44-0.76; P < 0.001; I2 = 34.3%; n = 28). GDT without Oliguria reversal as a target resulted in less ARF (OR, 0.45; 95% CI, 0.34-0.61; P < 0.001; I2 = 7.1%; n = 7) when compared with CFM with Oliguria reversal as a target. The studies comparing GDT with CFM in which the reversal of Oliguria was targeted in both or in neither group did not provide enough evidence to conclude a superiority of GDT (targeting Oliguria reversal in both protocols: OR, 0.63; 95% CI, 0.36-1.10; P = 0.09; I2 = 48.6%; n = 9, and in neither protocol: OR, 0.66; 95% CI, 0.37-1.16; P = 0.14; I2 = 20.2%; n = 12). CONCLUSIONS: Current literature favors targeting circulatory optimization by GDT without targeting Oliguria reversal to prevent ARF. Future studies are needed to investigate the hypothesis that targeting Oliguria reversal does not prevent ARF in critically ill and surgical patients.
Suvi T Vaara - One of the best experts on this subject based on the ideXlab platform.
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noninterventional follow up vs fluid bolus in response to Oliguria the response trial protocol and statistical analysis plan
Acta Anaesthesiologica Scandinavica, 2020Co-Authors: Nina Inkine, Tuomas Selande, Ville Pettila, Miia Valkone, Minna Acklund, J Wennervirta, Anni Pulkkine, Johanna Hastbacka, Suvi T VaaraAbstract:BACKGROUND Oliguria is a frequent trigger for administering a fluid bolus, but the effect of fluid bolus in improving urine output is inadequately demonstrated. Here, we summarize the protocol and detailed statistical analysis plan of the randomized, controlled RESPONSE trial comparing follow-up as the experimental group and a 500 mL crystalloid fluid bolus as the control group for Oliguria in critically ill oliguric patients. METHODS Our trial is an investigator-initiated, randomized, controlled, pilot trial conducted in three ICUs in two centers. We aim to randomize 1:1 altogether 130 hemodynamically stable oliguric patients either to a 2-hour follow-up without interventions or to receive a crystalloid bolus of 500 mL over 30 minutes. The primary outcome is the change in individual urine output during the 2-hour period compared to 2 hours preceding randomization. Doubling of the urine output is considered clinically significant. Additionally, we record the duration of Oliguria, physiological and biochemical variables, adverse events, and the incidences of acute kidney injury and renal replacement therapy. CONCLUSIONS Oliguria is a frequent trigger for potentially harmful fluid loading. Therefore, the RESPONSE trial will give information of the potential effect of fluid bolus on Oliguria in critically ill patients. TRIAL REGISTRATION clinical.trials.gov, NCT02860572.
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association of Oliguria with the development of acute kidney injury in the critically ill
Kidney International, 2016Co-Authors: Suvi T Vaara, Ville Pettila, Ilkka Parviaine, Sara Nisula, Outi Inkine, Ari UusaroAbstract:Urine output (UO) criterion may increase the sensitivity of the definition of acute kidney injury (AKI). We determined whether the empirically derived definition for Oliguria (
Brady S. Moffett - One of the best experts on this subject based on the ideXlab platform.
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renal effects of fenoldopam in critically ill pediatric patients a retrospective review
Pediatric Critical Care Medicine, 2008Co-Authors: Brady S. Moffett, Antonio R Mott, David P Nelson, Stuart L. Goldstein, John L JefferiesAbstract:Objective:Published data describe the use of fenoldopam in adults for treatment of Oliguria/anuria and for renal perfusion and protection, but pediatric data are scant. We assessed the effects of fenoldopam on urine output and potential deleterious changes in hemodynamics or serum creatinine in chil
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use of fenoldopam to increase urine output in a patient with renal insufficiency secondary to septic shock a case report
Pediatric Critical Care Medicine, 2006Co-Authors: Brady S. Moffett, Ren N OrellanaAbstract:Objective:We describe the use of fenoldopam to increase urine output in a pediatric patient with sepsis, heart failure, Oliguria, and volume overload.Design:Case report.Setting:A tertiary pediatric intensive care unit.Patient:A 17-year-old male who was being treated for acute lymphoblastic leukemia
