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Search Results: 1 - 10 of 13982 matches for " Eric AJ Hoste "
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Clinical review: Use of renal replacement therapies in special groups of ICU patients
Eric AJ Hoste, Annemieke Dhondt
Critical Care , 2012, DOI: 10.1186/cc10499
Abstract: The use of renal replacement therapy (RRT) in ICU patients is increasing over the years [1-3]. This increase may be explained by a higher number of ICU patients with older age and increased comorbidity, as well as by a decrease of exclusion criteria for RRT, such as in special groups of ICU patients - for example, those with haemodynamic instability and bleeding.RRT encompasses a broad range of techniques (Table 1). A distinction can be made based on duration (intermit-tent, continuous), membrane permeability (high flux, low flux), diffusion (haemodialysis) or convection (haemofiltration) or a combination of these (haemodiafiltration), and equipment used (machine for regular haemodialysis, single-pass batch system or machines that are specifically developed for continuous renal replacement therapy (CRRT)).Examples of continuous techniques include continuous haemodialysis, continuous venovenous haemofiltration (CVVH) and continuous venovenous haemodialfiltration (CVVHDF). Intermittent therapies include haemodialysis (HD) with varying duration, ranging from short (2 to 4 hours) to long (6 to 12 hours) as in sustained low-efficiency daily dialysis (or hybrid therapy, as it alternatively named). This form of intermittent RRT can be performed with a classic dialysis machine, and its dialysis characteristics are intermediate between classic HD and CRRT. Blood flow and dialysate flows are decreased and the treatment time is increased up to 6 to 12 hours per day. This treatment allows better haemodynamic tolerance and some hours per day off-machine, while the dialysis dose is maintained [4]. Intermittent haemodiafiltration can be applied as well, at least if online ultrapure water is available in the ICU.Peritoneal dialysis (PD) is very seldom used for the treatment of acute kidney injury (AKI) in ICU patients. Data on the use of this modality are scarce (only 240 adult patients were studied in three randomised studies) and come from developing countries. An initial report
Decompressive laparotomy for abdominal compartment syndrome – a critical analysis
Jan J De Waele, Eric AJ Hoste, Manu LNG Malbrain
Critical Care , 2006, DOI: 10.1186/cc4870
Abstract: We reviewed English literature from 1972 to 2004 for studies reporting the effects of decompressive laparotomy in patients with ACS. The effect of decompressive laparotomy on IAP, patient outcome and physiology were analysed.Eighteen studies including 250 patients who underwent decompressive laparotomy could be included in the analysis. IAP was significantly lower after decompression (15.5 mmHg versus 34.6 mmHg before, p < 0.001), but intraabdominal hypertension persisted in the majority of the patients. Mortality in the whole group was 49.2% (123/250). The effect of decompressive laparotomy on organ function was not uniform, and in some studies no effect on organ function was found. Increased PaO2/FIO2 ratio (PaO2 = partial pressure of oxygen in arterial blood, FiO2 = fraction of inspired oxygen) and urinary output were the most pronounced effects of decompressive laparotomy.The effects of decompressive laparotomy have been poorly investigated, and only a small number of studies report its effect on parameters of organ function. Although IAP is consistently lower after decompression, mortality remains considerable. Recuperation of organ dysfunction after decompressive laparotomy for ACS is variable.Intraabdominal hypertension (IAH) is a clearly identified cause of organ dysfunction in patients after emergency abdominal surgery and trauma [1-3]. It is also increasingly recognized in other patients in the intensive care unit (ICU), for example, after elective surgical procedures [4], liver transplantation [5], massive fluid resuscitation for extraabdominal trauma [6] and severe burns [7]. The presence of IAH at admission to the ICU has been associated with severe organ dysfunction during the ICU stay, and the development of IAH during ICU stay was an independent predictor of mortality [4].The clinical picture resulting from sustained IAH has been described as abdominal compartment syndrome (ACS). Although understanding of the pathophysiology of IAH has greatly improv
RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis
Eric AJ Hoste, Gilles Clermont, Alexander Kersten, Ramesh Venkataraman, Derek C Angus, Dirk De Bacquer, John A Kellum
Critical Care , 2006, DOI: 10.1186/cc4915
Abstract: We performed a retrospective cohort study, in seven intensive care units in a single tertiary care academic center, on 5,383 patients admitted during a one year period (1 July 2000–30 June 2001).Acute kidney injury occurred in 67% of intensive care unit admissions, with maximum RIFLE class R, class I and class F in 12%, 27% and 28%, respectively. Of the 1,510 patients (28%) that reached a level of risk, 840 (56%) progressed. Patients with maximum RIFLE class R, class I and class F had hospital mortality rates of 8.8%, 11.4% and 26.3%, respectively, compared with 5.5% for patients without acute kidney injury. Additionally, acute kidney injury (hazard ratio, 1.7; 95% confidence interval, 1.28–2.13; P < 0.001) and maximum RIFLE class I (hazard ratio, 1.4; 95% confidence interval, 1.02–1.88; P = 0.037) and class F (hazard ratio, 2.7; 95% confidence interval, 2.03–3.55; P < 0.001) were associated with hospital mortality after adjusting for multiple covariates.In this general intensive care unit population, acute kidney 'risk, injury, failure', as defined by the newly developed RIFLE classification, is associated with increased hospital mortality and resource use. Patients with RIFLE class R are indeed at high risk of progression to class I or class F. Patients with RIFLE class I or class F incur a significantly increased length of stay and an increased risk of inhospital mortality compared with those who do not progress past class R or those who never develop acute kidney injury, even after adjusting for baseline severity of illness, case mix, race, gender and age.Acute kidney injury is well recognized for its impact on the outcome of patients admitted to the intensive care unit (ICU). Illness severity scores such as the Acute Physiology and Chronic Health Evaluation version III (APACHE III) scoring system [1] and the Sequential Organ Failure Assessment score (SOFA) [2] both weight kidney dysfunction heavily (20% and 16.6% of the total scores for acute physiology). Yet t
Acute kidney injury in burns: a story of volume and inflammation
Kirsten Colpaert, Eric A Hoste
Critical Care , 2008, DOI: 10.1186/cc7106
Abstract: Steinvall and collaborators present the third study on acute kidney injury (AKI) defined by the RIFLE classification in patients with major burn injury [1]. AKI was formerly only considered relevant when there was a need for renal replacement therapy. We now know that moderate decreased kidney function also has an impact on patient outcomes [2]. Only since the first consensus definition for AKI, however – the RIFLE classification [3], which was modified later into the AKI staging system [4] – are we able to truly evaluate the epidemiology of AKI in diverse cohorts of patients. AKI has a population incidence greater than that of acute respiratory distress syndrome, and is comparable with that of sepsis [5]. The incidence rate in a general intensive care unit is on average 30% to 40%, but this rate varies according to the specific cohort.Despite the limitation that the study by Steinvall and colleagues includes only 127 patients with major burns, the study has several strengths. The authors present a very thorough evaluation of AKI, including many possible confounders for AKI. The cohort of patients also seems representative for burn unit patients in the western world [1].What did these studies learn, and how does the study of Steinvall and colleagues relate to the other two studies on this subject – those by Lopes and colleagues (n = 126) [6] and by Coca and colleagues (n = 304) [7]? Importantly, all three studies confirmed findings in other cohorts that increasing RIFLE class was associated with a stepwise increase of mortality. There was a large difference, however, in the incidence of AKI between the studies of Coca and colleagues and of Steinvall and colleagues (26.6% and 24.4%, respectively) compared with that of Lopes and colleagues (35.7% incidence). This difference cannot be explained by differences in baseline characteristics, such as age and total burned surface area. Other explanations should therefore be explored.The study by Lopes and colleagues classifi
Severe burn injury in europe: a systematic review of the incidence, etiology, morbidity, and mortality
Nele Brusselaers, Stan Monstrey, Dirk Vogelaers, Eric Hoste, Stijn Blot
Critical Care , 2010, DOI: 10.1186/cc9300
Abstract: The systematic literature search (1985 to 2009) involved PubMed, the Web of Science, and the search engine Google. The reference lists and the Science Citation Index were used for hand searching (snowballing). Only studies dealing with epidemiologic issues (for example, incidence and outcome) as their major topic, on hospitalized populations with severe burn injury (in secondary and tertiary care) in Europe were included. Language restrictions were set on English, French, and Dutch.The search led to 76 eligible studies, including more than 186,500 patients in total. The annual incidence of severe burns was 0.2 to 2.9/10,000 inhabitants with a decreasing trend in time. Almost 50% of patients were younger than 16 years, and ~60% were male patients. Flames, scalds, and contact burns were the most prevalent causes in the total population, but in children, scalds clearly dominated. Mortality was usually between 1.4% and 18% and is decreasing in time. Major risk factors for death were older age and a higher total percentage of burned surface area, as well as chronic diseases. (Multi) organ failure and sepsis were the most frequently reported causes of death. The main causes of early death (<48 hours) were burn shock and inhalation injury.Despite the lack of a large-scale European registration of burn injury, more epidemiologic information is available about the hospitalized population with severe burn injury than is generally presumed. National and international registration systems nevertheless remain necessary to allow better targeting of prevention campaigns and further improvement of cost-effectiveness in total burn care.Burn injury is a common type of traumatic injury, causing considerable morbidity and mortality. Moreover, burns are also among the most expensive traumatic injuries, because of long hospitalization and rehabilitation, and costly wound and scar treatment [1,2].Worldwide, an estimated 6 million patients seek medical help for burns annually, but the majo
Pro/con debate: Continuous versus intermittent dialysis for acute kidney injury: a never-ending story yet approaching the finish?
Raymond Vanholder, Wim Van Biesen, Eric Hoste, Norbert Lameire
Critical Care , 2011, DOI: 10.1186/cc9345
Abstract: Few topics in nephrology have been the subject of so many randomized controlled trials (RCTs), meta-analyses and reviews than that of extracorporeal renal replacement in acute kidney injury (AKI). Since the introduction of hemodialysis as a valid treatment for renal failure by Kolff in the early 1940 s [1], intermittent renal replacement therapy (IRRT) was offered as a bridge until recovery of kidney function; first in a low-efficient and therefore protracted version, later becoming progressively shorter. In the 1980 s, Kramer and colleagues introduced continuous renal replacement therapy (CRRT) as an alternative, allowing blood purification 24 hours per day - at least in principle [2].CRRT originally applied a simple concept without pumps or technology (continuous arteriovenous hemofiltration). Since this approach often lacked efficiency, however, machines containing blood pumps soon made their appearance (continuous venovenous hemofiltration). Whereas solute removal with IRRT at the origin essentially made use of diffusion - that is, gradient-related molecule shifts in a liquid milieu from higher to lower concentration gradients - CRRT started as a convective strategy, driven by removal of solute-containing ultrafiltrate through large pores and its replacement by substitution fluid. With time, diffusion was also implied in CRRT by introducing additional pumps to the machines, while convective strategies became more widely applied in IRRT. Characteristics of CRRT and IRRT tended to converge further at the beginning of this century in a concept named sustained low-efficiency daily dialysis (SLEDD) [3], by applying IRRT mostly at lower blood and dialysate flows but at prolonged dialysis times. The term low efficiency is, however, in many cases a misnomer [4,5]. Sometimes, this strategy is also named prolonged intermittent renal replacement therapy.It is difficult to find a uniform definition of SLEDD in the literature. In fact, one of the advantages of SLEDD lies in
Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury
Kianoush Kashani, Ali Al-Khafaji, Thomas Ardiles, Antonio Artigas, Sean M Bagshaw, Max Bell, Azra Bihorac, Robert Birkhahn, Cynthia M Cely, Lakhmir S Chawla, Danielle L Davison, Thorsten Feldkamp, Lui G Forni, Michelle Gong, Kyle J Gunnerson, Michael Haase, James Hackett, Patrick M Honore, Eric AJ Hoste, Olivier Joannes-Boyau, Michael Joannidis, Patrick Kim, Jay L Koyner, Daniel T Laskowitz, Matthew E Lissauer, Gernot Marx, Peter A McCullough, Scott Mullaney, Marlies Ostermann, Thomas Rimmelé, Nathan I Shapiro, Andrew D Shaw, Jing Shi, Amy M Sprague, Jean-Louis Vincent, Christophe Vinsonneau
Critical Care , 2013, DOI: 10.1186/cc12503
Abstract: We performed two multicenter observational studies in critically ill patients at risk for AKI - discovery and validation. The top two markers from discovery were validated in a second study (Sapphire) and compared to a number of previously described biomarkers. In the discovery phase, we enrolled 522 adults in three distinct cohorts including patients with sepsis, shock, major surgery, and trauma and examined over 300 markers. In the Sapphire validation study, we enrolled 744 adult subjects with critical illness and without evidence of AKI at enrollment; the final analysis cohort was a heterogeneous sample of 728 critically ill patients. The primary endpoint was moderate to severe AKI (KDIGO stage 2 to 3) within 12 hours of sample collection.Moderate to severe AKI occurred in 14% of Sapphire subjects. The two top biomarkers from discovery were validated. Urine insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2), both inducers of G1 cell cycle arrest, a key mechanism implicated in AKI, together demonstrated an AUC of 0.80 (0.76 and 0.79 alone). Urine [TIMP-2].[IGFBP7] was significantly superior to all previously described markers of AKI (P <0.002), none of which achieved an AUC >0.72. Furthermore, [TIMP-2].[IGFBP7] significantly improved risk stratification when added to a nine-variable clinical model when analyzed using Cox proportional hazards model, generalized estimating equation, integrated discrimination improvement or net reclassification improvement. Finally, in sensitivity analyses [TIMP-2].[IGFBP7] remained significant and superior to all other markers regardless of changes in reference creatinine method.Two novel markers for AKI have been identified and validated in independent multicenter cohorts. Both markers are superior to existing markers, provide additional information over clinical variables and add mechanistic insight into AKI. Trial registration: ClinicalTrials.gov number NCT01209169.
Intra-abdominal hypertension in patients with severe acute pancreatitis
Jan J De Waele, Eric Hoste, Stijn I Blot, Johan Decruyenaere, Francis Colardyn
Critical Care , 2005, DOI: 10.1186/cc3754
Abstract: We studied all patients admitted to the intensive care unit (ICU) because of SAP in a 4 year period. The incidence of IAH (defined as intra-abdominal pressure ≥ 15 mmHg) was recorded. The occurrence of organ dysfunction during ICU stay was recorded, as was the length of stay in the ICU and outcome.The analysis included 44 patients, and IAP measurements were obtained from 27 patients. IAH was found in 21 patients (78%). The maximum IAP in these patients averaged 27 mmHg. APACHE II and Ranson scores on admission were higher in patients who developed IAH. The incidence of organ dysfunction was high in patients with IAH: respiratory failure 95%, cardiovascular failure 91%, and renal failure 86%. Mortality in the patients with IAH was not significantly higher compared to patients without IAH (38% versus 16%, p = 0.63), but patients with IAH stayed significantly longer in the ICU and in the hospital. Four patients underwent abdominal decompression because of abdominal compartment syndrome, three of whom died in the early postoperative course.IAH is a frequent finding in patients admitted to the ICU because of SAP, and is associated with a high occurrence rate of organ dysfunction. Mortality is high in patients with IAH, and because the direct causal relationship between IAH and organ dysfunction is not proven in patients with SAP, surgical decompression should not routinely be performed.Despite recent advances in the management of patients, such as early enteral nutrition and withholding surgery until proven infection of pancreatic necrosis, severe acute pancreatitis (SAP) remains a disease with an unpredictable clinical course and significant morbidity and mortality [1]. Infection still remains the most feared complication, but also the presence of organ dysfunction is increasingly recognized as an important risk factor for mortality in patients with severe disease [2-4].Intra-abdominal hypertension (IAH) has been recognized as a cause of organ dysfunction in critically
Torus knots are Fourier-(1,1,2) knots
Jim Hoste
Mathematics , 2007,
Abstract: Every torus knot can be represented as a Fourier-(1,1,2) knot which is the simplest possible Fourier representation for such a knot. This answers a question of Kauffman and confirms the conjecture made by Boocher, Daigle, Hoste and Zheng. In particular, the torus knot T(p,q) can be parameterized as x(t)=cos(pt), y(t)=cos(qt+pi/(2p)), and z(t)=cos(pt+pi/2)\cos((q-p)t+pi/(2p)-pi/(4q)).
A novel approach for prediction of tacrolimus blood concentration in liver transplantation patients in the intensive care unit through support vector regression
Stijn Van Looy, Thierry Verplancke, Dominique Benoit, Eric Hoste, Georges Van Maele, Filip De Turck, Johan Decruyenaere
Critical Care , 2007, DOI: 10.1186/cc6081
Abstract: Tacrolimus blood concentrations, together with 35 other relevant variables from 50 liver transplantation patients, were extracted from our ICU database. This resulted in a dataset of 457 blood samples, on average between 9 and 10 samples per patient, finally resulting in a database of more than 16,000 data values. Nonlinear RBF SVR, linear SVR, and MLR were performed after selection of clinically relevant input variables and model parameters. Differences between observed and predicted tacrolimus blood concentrations were calculated. Prediction accuracy of the three methods was compared after fivefold cross-validation (Friedman test and Wilcoxon signed rank analysis).Linear SVR and nonlinear RBF SVR had mean absolute differences between observed and predicted tacrolimus blood concentrations of 2.31 ng/ml (standard deviation [SD] 2.47) and 2.38 ng/ml (SD 2.49), respectively. MLR had a mean absolute difference of 2.73 ng/ml (SD 3.79). The difference between linear SVR and MLR was statistically significant (p < 0.001). RBF SVR had the advantage of requiring only 2 input variables to perform this prediction in comparison to 15 and 16 variables needed by linear SVR and MLR, respectively. This is an indication of the superior prediction capability of nonlinear SVR.Prediction of tacrolimus blood concentration with linear and nonlinear SVR was excellent, and accuracy was superior in comparison with an MLR model.Tacrolimus blood concentrations demonstrate a wide intra- and interindividual variability. Therefore, monitoring of these concentrations remains an issue of pivotal importance to safeguard therapeutic efficacy and to manage the risk for nephrotoxicity, other toxicities, and rejection in liver transplantation patients [1]. This study examines the feasibility and clinical benefits of using a support vector regression (SVR) algorithm in comparison with a multiple linear regression (MLR) algorithm in predicting tacrolimus blood concentration. Tacrolimus blood concentratio
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