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Items 1 - 23 of 23 |
One page. |
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Randomized trial of an intensive care unit-based early discharge planning intervention for critically ill elderly patients.
Kleinpell RM.
Rush University College of Nursing, Chicago, Ill, USA.
BACKGROUND: Few investigators have targeted elderly patients and monitored outcomes of care in studies on discharge planning interventions after critical illness. OBJECTIVES: To pilot test an intensive care unit-based nursing screening intervention to assist in determining the discharge needs and outcomes of critically ill elderly patients. METHOD: A randomized clinical trial with in-hospital and mailed questionnaires was used. Patients 65 years and older who were hospitalized in 1 of 2 intensive care units at 2 midwestern university-affiliated medical centers were recruited for the study. Control patients (n = 53) received usual discharge planning, experimental patients (n = 47) were screened in the intensive care unit by using the Discharge Planning Questionnaire. Both groups were assessed for readiness for discharge when discharged from the hospital and were followed up 2 weeks later with a survey completed at home. RESULTS: One hundred patients 65 to 90 years old (mean 73, SD 5.78) completed the study. Sixty-six percent were men. The 2 groups did not differ with regard to age, race, sex, severity of illness, lengths of stay in the intensive care unit or hospital, education level, or income. Patients in the experimental group were more ready than patients in the control group for discharge (P =.06). Patients in the experimental group were also more likely to report they had adequate information, had less concern about managing their care at home, knew their medicines, and knew danger signals indicating potential complications. CONCLUSION: Intensive care unit-based early discharge planning can affect elderly patients' preparation for discharge.
PMID: 15293587 [PubMed - in process]
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Documentation on withdrawal of life support in adult patients in the intensive care unit.
Kirchhoff KT, Anumandla PR, Foth KT, Lues SN, Gilbertson-White SH.
University of Wisconsin, School of Nursing, Madison, Wis, USA.
BACKGROUND: Patients' charts have been a source of data for retrospective studies of the quality of end-of-life care. In the intensive care unit, most patients die after withdrawal of life support. Chart reviews of this process could be used not only to assess the quality of documentation but also to provide information for quality improvement and research. OBJECTIVE: To assess the documentation of end-of-life care of patients and their families by care providers in the intensive care unit. METHOD: Charts of 50 adult patients who died in the intensive care unit at a large midwestern hospital after initiation of withdrawal of life support (primarily mechanical ventilation) were reviewed. A form developed for the study was used for data collection. RESULTS: The initiation of the decision making for withdrawal was documented in all 50 charts. Sixteen charts (32%) had no information on advance directives. Eight charts (16%) had no documentation on resuscitation status. About two thirds of the charts documented nurses' participation during the withdrawal process; only one tenth documented physicians' participation. A total of 13 charts (26%) had no information on the time of initiation of the withdrawal process, and 11 (22%) had no documentation of medications administered for withdrawal. Thirty-seven charts (74%) had information on whether the patient was or was not extubated during withdrawal. CONCLUSION: Comprehensive documentation of end-of-life care is lacking.
PMID: 15293586 [PubMed - in process]
Comment on:
Critical care and obstructive sleep apnea.
Johnson DC.
Publication Types:
PMID: 15220127 [PubMed - indexed for MEDLINE]
Comment on:
The survival benefit of intensive care.
Danis M.
Publication Types:
PMID: 15286563 [PubMed - indexed for MEDLINE]
Comment on:
Nurse-assessed tool for evaluating death in the intensive care unit.
Azoulay E.
Publication Types:
PMID: 15286562 [PubMed - indexed for MEDLINE]
Erratum in:
- Crit Care Med. 12004 Sep;32(9):985.
Comment on:
Evolution of B-type natriuretic peptide in evaluation of intensive care unit shock.
Bhalla V, Bhalla MA, Maisel AS.
Publication Types:
PMID: 15286561 [PubMed - indexed for MEDLINE]
Comment in:
Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care unit beds.
Simchen E, Sprung CL, Galai N, Zitser-Gurevich Y, Bar-Lavi Y, Gurman G, Klein M, Lev A, Levi L, Zveibil F, Mandel M, Mnatzaganian G.
Department of Health Services Research, Ministry of Health, Jerusalem, Israel.
OBJECTIVE: The demand for intensive care beds far exceeds their availability in many European countries. Consequently, many critically ill patients occupy hospital beds outside intensive care units, throughout the hospital. The outcome of patients who fit intensive care unit admission criteria but are hospitalized in regular wards needs to be assessed for policy implications. The object was to screen entire hospital patient populations for critically ill patients and compare their 30-day survival in and out of the intensive care unit. DESIGN: Screening teams visited every hospital ward on four selected days in five acute care Israeli hospitals. The teams listed all patients fitting a priori developed study criteria. One-month data for each patient were abstracted from the medical records. SETTING: Five acute care Israeli hospitals. PATIENTS: All patients fitting a priori developed study criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Survival in and out of the intensive care unit was compared for screened patients from the day a patient first met study criteria. Cox multivariate models were constructed to adjust survival comparisons for various confounding factors. The effect of intensive care unit vs. other departments was estimated separately for the first 3 days after deterioration and for the remaining follow-up time. Results showed that 5.5% of adult hospitalized patients were critically ill (736 of 13,415). Of these, 27% were admitted to intensive care units, 24% to specialized care units, and 49% to regular departments. Admission to an intensive care unit was associated with better survival during the first 3 days of deterioration, after we adjusted for age and severity of illness (p =.018). There was no additional survival advantage for intensive care unit patients (p =.9) during the remaining follow-up time. CONCLUSIONS: The early survival advantage in the intensive care unit suggests a window of critical opportunity for these patients. Under economic constraints and dearth of intensive care unit beds, increasing the turnover of patients in the intensive care unit, thus exposing more needy patients to the early benefit of treatment in the intensive care unit, may be advantageous.
PMID: 15286540 [PubMed - indexed for MEDLINE]
Comment in:
Factors associated with nurse assessment of the quality of dying and death in the intensive care unit.
Hodde NM, Engelberg RA, Treece PD, Steinberg KP, Curtis JR.
Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA.
OBJECTIVE: To determine the feasibility of using nurse ratings of quality of dying and death to assess quality of end-of-life care in the intensive care unit and to determine factors associated with nurse assessment of the quality of dying and death for patients dying in the intensive care unit. DESIGN: Prospective cohort study. SETTING: Hospital intensive care unit. PATIENTS: 178 patients who died in an intensive care unit during a 10-month period at one hospital. INTERVENTIONS: Nurses completed a 14-item questionnaire measuring the quality of dying and death in the intensive care unit (QODD); standardized chart reviews were also completed. MEASUREMENTS AND MAIN RESULTS: Five variables were found to be associated with QODD scores. Higher (better) scores were significantly associated with having someone present at the time of death (p <.001), having life support withdrawn (p =.006), having an acute diagnosis such as intracranial hemorrhage or trauma (p =.007), not having cardiopulmonary resuscitation in the last 8 hrs of life (p <.001), and being cared for by the neurosurgery or neurology services (p =.002). Patient age, chronic disease, and Glasgow Coma Scale scores were not associated with the 14-item QODD. Using multivariate analyses, we identified three variables as independent predictors of the QODD score: a) not having cardiopulmonary resuscitation performed in the last 8 hrs of life; b) having someone present at the moment of death; and c) being cared for by neurosurgery or neurology services. CONCLUSIONS: Intensive care unit nurse assessment of quality of dying and death is a feasible method for obtaining quality ratings. Based on nurse assessments, this study provides evidence of some potential targets for interventions to improve the quality of dying for some patients: having someone present at the moment of death and not having cardiopulmonary resuscitation in the last 8 hrs of life. If nurse-assessed quality of dying is to be a useful tool for measuring and improving quality of end-of-life care, it is important to understand the factors associated with nurse ratings.
PMID: 15286539 [PubMed - indexed for MEDLINE]
Comment in:
Utility of B-type natriuretic peptide for the evaluation of intensive care unit shock.
Tung RH, Garcia C, Morss AM, Pino RM, Fifer MA, Thompson BT, Lewandrowski K, Lee-Lewandrowski E, Januzzi JL.
Department of Medicine, Massachusetts General Hospital, Boston, MA.
OBJECTIVES: Among patients with congestive heart failure, B-type natriuretic peptide measurement is useful to estimate filling pressures and to prognosticate adverse outcome. However, among critically ill intensive care unit patients with shock, the utility of B-type natriuretic peptide to assess cardiac hemodynamics or prognosis has not been explored. DESIGN: Clinical investigation. SETTING: Hospital. PATIENTS: Forty-nine patients with shock and indication for pulmonary artery catheterization. INTERVENTIONS: Analysis for B-type natriuretic peptide was performed on blood obtained at the time of catheter placement. MEASUREMENTS AND MAIN RESULTS: Correlations between B-type natriuretic peptide and pulmonary artery occlusion pressure as well as cardiac index were calculated using Spearman analysis. Mortality at the time of study completion was correlated with B-type natriuretic peptide values and Acute Physiology and Chronic Health Evaluation II scores, and logistic regression identified independent predictors of mortality. A wide range of B-type natriuretic peptide concentrations was seen in intensive care unit patients (<5 to >5000 pg/mL); only eight patients (16%) had normal B-type natriuretic peptide concentrations. Log-transformed B-type natriuretic peptide concentrations did not correlate with interpatient cardiac index or pulmonary artery occlusion pressure (all p = not significant); however, a B-type natriuretic peptide <350 pg/mL had a negative predictive value of 95% for the diagnosis of cardiogenic shock. Median B-type natriuretic peptide concentrations were higher in those who died than those who survived (943 pg/mL vs. 378 pg/mL, p <.001). In multivariable analysis, a B-type natriuretic peptide concentration in the highest log-quartile was the strongest predictor of mortality (odds ratio = 4.50, 95% confidence interval = 1.87-99.0, p <.001). CONCLUSION: B-type natriuretic peptide concentrations are frequently elevated among critically ill patients in the intensive care unit and cannot be used as a surrogate for pulmonary artery catheterization. B-type natriuretic peptide concentrations in intensive care unit shock may provide powerful information for use in mortality prediction.
Publication Types:
PMID: 15286538 [PubMed - indexed for MEDLINE]
Comment on:
Stress ulcer prophylaxis.
DePriest JL.
Publication Types:
PMID: 15241125 [PubMed - indexed for MEDLINE]
Comment on:
Access to critical care: medical rationing of a public right or privilege?
Szalados JE.
Unity Health System, Westside Anesthesiology, Associates of Rochester, Rochester, NY, USA.
Publication Types:
PMID: 15241122 [PubMed - indexed for MEDLINE]
Comment on:
Perfusing the brain after traumatic brain injury: what clinical index should we follow?
Vespa PM.
Publication Types:
PMID: 15241121 [PubMed - indexed for MEDLINE]
Comment on:
How will we respond to chronic critical illness?
Danis M.
Publication Types:
PMID: 15241118 [PubMed - indexed for MEDLINE]
Comment on:
Affordable health care for all Canadians?
Teres D, Rapoport J, Jacobs P.
Publication Types:
PMID: 15241116 [PubMed - indexed for MEDLINE]
Comment on:
Acute brain injury: if hypothermia is good, then is hyperthermia bad?
Manno EM, Farmer JC.
Publication Types:
PMID: 15241114 [PubMed - indexed for MEDLINE]
Comment in:
Rationing critical care beds: a systematic review.
Sinuff T, Kahnamoui K, Cook DJ, Luce JM, Levy MM; Values Ethics and Rationing in Critical Care Task Force.
OBJECTIVE: Rationing critical care beds occurs daily in the hospital setting. The objective of this systematic review was to examine the impact of rationing intensive care unit beds on the process and outcomes of care. DATA SOURCE: We searched MEDLINE (1966-2003), CINAHL (1982-2003), Ovid Healthstar (1975-2003), EMBASE (1980-2003), Scisearch (1980-2003), the Cochrane Library, PUBMED related articles, personal files, abstract proceedings, and reference lists. STUDY SELECTION: We included studies of seriously ill patients considered for admission to an intensive care unit bed during periods of reduced availability. We had no restriction on study design. Studies were excluded if rationing was performed using a scoring system or protocol and if cost-effectiveness was the only outcome. DATA EXTRACTION: In duplicate and independently, we performed data abstraction and quality assessment. DATA SYNTHESIS: We included ten observational studies. Hospital mortality rate was increased in patients refused intensive care unit admission vs. those admitted (odds ratio, 3.04; 95% confidence interval, 1.49-6.17). Factors associated with both intensive care unit bed refusal and increased mortality rate were increased age, severity of illness, and medical diagnosis. When intensive care unit beds were reduced, admitted patients were sicker, were less often admitted primarily for monitoring, and had a shorter intensive care unit length of stay, without other observed adverse effects. CONCLUSIONS: These studies suggest that patients who are perceived not to benefit from critical care are more often refused intensive care unit admission; refusal is associated with an increased risk of hospital death. During times of decreased critical bed availability, several factors, including age, illness severity, and medical diagnosis, are used to triage patients, although their relative importance is uncertain. Critical care bed rationing requires further investigation.
Publication Types:
PMID: 15241106 [PubMed - indexed for MEDLINE]
Comment in:
Relationship between brain perfusion computed tomography variables and cerebral perfusion pressure in severe head trauma patients.
Wintermark M, Chiolero R, van Melle G, Revelly JP, Porchet F, Regli L, Meuli R, Schnyder P, Maeder P.
Department of Diagnostic and Interventional Radiology, University Hospital, Lausanne, Switzerland.
OBJECTIVE: To compare brain perfusion-computed tomography (CT) results with invasive cerebral perfusion pressure (CPP) monitoring in severe head trauma patients. DESIGN: Prospective cohort study. SETTING: Emergency room and surgical intensive care unit of our hospital. PATIENTS: Sixty-one severe head trauma patients. INTERVENTIONS: We prospectively collected 103 perfusion-CT examinations with simultaneous measurement of mean arterial pressure and intracranial pressure, affording calculation of CPP. The statistical relationship between perfusion-CT results and the corresponding CPP values was evaluated using Wilcoxon (Mann-Whitney) and generalized F-tests. The functional outcome of the 61 patients was evaluated 3 months after trauma on the basis of the Glasgow Outcome Scale score and compared between groups using Fisher's exact tests. MEASUREMENTS AND MAIN RESULTS: Perfusion-CT enabled us to distinguish between two groups of patients. Within each group, a significant correlation (p <.001) between the CPP values and the corresponding perfusion-CT results was demonstrated. There was also a significant correlation (p <.001) between the CPP values and the extent of the abnormal perfusion-CT areas (R up to.817).The first group was characterized by a weak dependence of perfusion-CT results on the corresponding CPP values (low slope) and the second group by a strong dependence (steep slope). These groups were interpreted as having preserved (or pseudo) and impaired cerebral vascular autoregulation, respectively. The functional outcome was better in the second group of patients. CONCLUSIONS: Intermittent perfusion-CT measurements plus continuous CPP measurement provide more information than continuous CPP alone. Perfusion-CT gives unique information regarding regional heterogeneity of brain perfusion. It might allow clinicians to distinguish between patients with preserved auto-regulation (or pseudoautoregulation) and those with impaired autoregulation and could therefore guide interpretation of CPP measurements and therapy.
PMID: 15241105 [PubMed - indexed for MEDLINE]
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Effect of prolongation of expiratory time on dynamic hyperinflation in mechanically ventilated patients with severe asthma.
Leatherman JW, McArthur C, Shapiro RS.
Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
OBJECTIVE: To assess the effect of a decrease in respiratory rate on dynamic hyperinflation, as determined by changes in plateau airway pressure, in patients with status asthmaticus whose baseline minute ventilation approximated 10 L/min. DESIGN: Observational descriptive study. SETTING: Medical intensive care unit. PATIENTS: Twelve patients with severe asthma mechanically ventilated in the assist control mode with a tidal volume of 613 +/- 100 mL and an inspiratory flow rate of 79 +/- 4 L/min. INTERVENTIONS: A decrease in respiratory rate from 18 to 12 and 6 breaths/min. MEASUREMENTS AND MAIN RESULTS: Plateau airway pressure decreased by approximately 2 cm H2O (25.4 +/- 2.8 vs. 23.3 +/- 2.6 cm H2O, p <.01) when respiratory rate was decreased from 18 to 12 breaths/min (increase in expiratory time 1.7 secs) and by a similar amount (23.3 +/- 2.6 vs. 21.3 +/- 2.9 cm H2O, p <.01) when respiratory rate was decreased from 12 to 6 breaths/min (increase in expiratory time 5 secs). Peak airway pressure was similar at the three respiratory rates (66.8 +/- 8.7 vs. 66.4 +/- 9.5 vs. 67.8 +/- 11.1 cm H2O at 18, 12, and 6 breaths/min, respectively). End-expiratory flow rates (n = 7) were 61.4 +/- 12.6, 38.6 +/- 4.5, and 23.1 +/- 5.8 mL/sec at respiratory rates of 18, 12, and 6 breaths/min, respectively. CONCLUSIONS: Prolongation of expiratory time decreases dynamic hyperinflation in patients with status asthmaticus, as evidenced by a reduction in plateau airway pressure, but the magnitude of this effect is relatively modest when baseline minute ventilation is < or = 10 L/min, because of the low end-expiratory flow rates. Since flow progressively decreases throughout expiration, the reduction in dynamic hyperinflation resulting from a given prolongation of expiratory time will depend on the baseline respiratory rate (i.e., less reduction in dynamic hyperinflation at a lower respiratory rate). Changes in peak airway pressure may not always reflect the changes in dynamic hyperinflation that result from prolongation of expiratory time.
PMID: 15241099 [PubMed - indexed for MEDLINE]
Comment in:
The symptom burden of chronic critical illness.
Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Morrison RS.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. Judith.nelson@mountsinai.org
OBJECTIVE: To assess self-reported symptom burden of chronic critical illness. DESIGN: Prospective cohort study. SETTING: Respiratory care unit for treatment of chronically critically ill patients at an academic, tertiary-care, urban medical center. PATIENTS: Fifty patients who underwent elective tracheotomy and transfer from an adult intensive care unit to the respiratory care unit for weaning from mechanical ventilation. INTERVENTIONS: Assessment of physical and psychological symptoms through patients' self-reports using a modification of the Condensed Form of the Memorial Symptom Assessment Scale. MEASUREMENTS AND MAIN RESULTS: We measured self-reported symptom burden, ventilator outcomes, and vital status and functional status at discharge and 3 and 6 months after discharge. Half of the patients were successfully liberated from mechanical ventilation, but most hospital survivors were discharged to skilled nursing facilities and more than half of the cohort was dead at 3 months after discharge. Seventy-two percent (36 of 50) of patients were able to self-report symptoms during the period of respiratory care unit treatment. Among patients responding to symptom assessment, approximately 90% were symptomatic. Forty-four percent of patients reported pain at the highest levels. More than 60% reported psychological symptoms at these levels, and approximately 90% of patients reported severe distress due to difficulty communicating. CONCLUSIONS: Physical and psychological symptom distress is common and severe among patients receiving treatment for chronic critical illness. The majority of these patients die soon after hospital discharge. Given the level of distress in our study patients and the high mortality rate that we and others have observed, greater attention should be given to relief of pain and other distressing symptoms and to assessment of burdens and benefits of treatment for the chronically critically ill.
PMID: 15241097 [PubMed - indexed for MEDLINE]
Comment in:
New method of classifying infections in critically ill patients.
Cohen J, Cristofaro P, Carlet J, Opal S.
Department of Medicine, Brighton and Sussex Medical School, Falmer, UK.
OBJECTIVE: To develop a systematic classification describing the contribution made by infection to the outcome from sepsis. CONTEXT: The emergence of effective therapies for sepsis means that accurate methods of risk assessment are of increasing importance. Although there are well-validated instruments for describing risk factors in the host, the contribution made by the infection is less well served. DESIGN AND METHODS: A systematic literature review of the English language literature published during the last 30 yrs of studies describing the outcome of infections, categorized by micro-organism and site of infection. RESULTS: We surveyed 510 published articles including 55,854 clinical infections, and we generated specific risk codes for bacteremia, meningitis, pneumonia, skin and soft tissue infections, peritonitis, and urinary tract infections. Both the nature of the organisms and the site of infection have a significant impact on survival from sepsis, and there is a significant interaction between them. CONCLUSION: We have described a novel approach to permit a better assessment of the contribution made by the infection to mortality in patients with sepsis or septic shock.
Publication Types:
PMID: 15241096 [PubMed - indexed for MEDLINE]
Comment in:
Mechanical ventilation in Ontario, 1992-2000: incidence, survival, and hospital bed utilization of noncardiac surgery adult patients.
Needham DM, Bronskill SE, Sibbald WJ, Pronovost PJ, Laupacis A.
Department of Critical Care Medicine and Medicine, University of Toronto, Toronto, Canada.
OBJECTIVE: Mechanical ventilation is a common therapy used in caring for critically ill patients, but its epidemiology is poorly understood. We describe population-based, temporal trends in the incidence, survival, and hospital bed utilization of mechanically ventilated, noncardiac surgery adult patients. DESIGN: Retrospective, observational cohort study using linked administrative databases. SETTING: Province of Ontario, Canada. PATIENTS: Subjects were 150,755 unique patients who received mechanical ventilation between 1992 and 2000. INTERVENTIONS: None. MEASUREMENTS: Annual measures of mechanical ventilation incidence, 30-day patient mortality rate, and number of mechanical ventilation days and inpatient days for mechanically ventilated patients as a proportion of total adult inpatient bed days. MAIN RESULTS: From 1992 to 2000, the crude and age- and gender-adjusted incidence of mechanical ventilation increased 9% (p <.001) and 2% (p <.027), respectively, to 217 per 100,000 adults. Crude mortality rate 30 days after initiation of mechanical ventilation increased from 27% to 32% (p <.001). Significant predictors of 30-day mortality rate (adjusted hazard ratio, 95% confidence interval) were calendar year (1.03, 1.02-1.03), age >80 yrs (2.3, 2.2-2.3), Charlson score 3+ (2.0, 2.0-2.1), and specific diagnosis. From 1992 to 2000, the number of mechanical ventilation days and inpatient days for mechanically ventilated patients, as a proportion of total adult inpatient bed days, increased 69% and 30% (both p <.001), respectively, to 1.8% and 6.2%. CONCLUSIONS: There was a small, but important, increase in mechanical ventilation incidence and a substantial increase in the proportion of inpatient bed days used by mechanically ventilated patients in Ontario during the 1990s. These trends are important in planning for expansion of health care resources to meet the needs of the aging population. The increase, over time, in risk-adjusted mortality rate of mechanically ventilated patients is concerning and requires further investigation.
PMID: 15241095 [PubMed - indexed for MEDLINE]
Year in review in intensive care medicine-2003. Part 3: intensive care unit organization, scoring, quality of life, ethics, neonatal and pediatrics, and experimental.
Abraham E, Andrews P, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pinsky M, Radermacher P, Ranieri M, Richard C, Tasker R, Vallet B.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
PMID: 15292983 [PubMed - in process]
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Bedside estimation of absolute renal blood flow and glomerular filtration rate in the intensive care unitA validation of two independent methods.
Sward K, Valsson F, Sellgren J, Ricksten SE.
Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital Goteborg, 41345, Goteborg, Sweden.
OBJECTIVE. To evaluate various treatment strategies in critically ill patients with ischaemic acute renal failure, there is a need for reliable bedside measurements of total renal blood flow (RBF), glomerular filtration rate (GFR) and renal oxygen consumption without the need for urine collection. DESIGN. The continuous renal vein thermodilution method and the infusion clearance techniques were validated against the gold standard technique, the urinary clearance of paraaminohippurate (PAH) and chromium ethylenediaminetetraacetic acid, respectively. SETTING. University hospital cardiothoracic ICU. PATIENTS. Seventeen uncomplicated mechanically ventilated post-cardiac surgical patients. INTERVENTIONS. None. MEASUREMENTS AND RESULTS. Renal blood flow, GFR and the renal filtration fraction (FF) were measured for two consecutive 30-min periods by urinary clearance and compared with simultaneous measurements made by the thermodilution and infusion clearance techniques. Urinary clearance for PAH was corrected for by renal extraction of PAH. The within-group error, repeatability coefficient and the coefficient of variation were highest for the thermodilution technique and lowest for the infusion clearance technique with regard to RBF, GFR and FF. The infusion clearance technique had a higher agreement with the urinary clearance method than the thermodilution method. For estimations of RBF and GFR, the between-group errors were 33% and 43% comparing infusion clearance with urinary clearance and 65% and 67% comparing thermodilution with urinary clearance. CONCLUSIONS. The infusion clearance method had the highest reproducibility and the highest agreement with the urinary clearance reference method. The renal vein thermodilution technique is less reliable in the ICU setting due to poor repeatability and poor agreement with the reference method.
PMID: 15290027 [PubMed - as supplied by publisher]
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