Coagulation support during perioperative bleeding management

Journal article

Background: Acute kidney injury (AKI) is a significant complication in pediatric intensive care units (PICU), associated with increased morbidity and mortality. Understanding its risk factors and outcomes is crucial for improving patient care. Objective: To evaluate the incidence, risk factors, and clinical outcomes of AKI in PICU patients through a prospective observational study. Methods: We prospectively studied 40 children aged 1 month to 18 years admitted to the PICU. AKI was defined and staged according to KDIGO criteria. Clinical parameters, laboratory values, and outcomes were monitored. Risk factors were analyzed using multivariate logistic regression. Results: AKI developed in 15 patients (37.5%), with 46.7% classified as Stage 1, 33.3% as Stage 2, and 20% as Stage 3. Significant independent risk factors included nephrotoxic medication exposure (adjusted OR 4.1, 95% CI 1.9-8.8), mechanical ventilation (adjusted OR 3.2, 95% CI 1.6-6.4), and sepsis (adjusted OR 2.9, 95% CI 1.4-6.0). AKI patients demonstrated longer PICU stays (median 12 vs 7 days, p=0.003), increased mechanical ventilation duration (median 8 vs 4 days, p=0.001), and higher mortality (26.7% vs 8%, p=0.04). Among survivors with AKI, 26.7% showed persistent renal dysfunction at discharge. Conclusion: AKI occurs frequently in PICU patients and is associated with worse clinical outcomes. Early recognition of risk factors and implementation of preventive strategies may help improve patient outcomes. Regular monitoring of renal function and post-discharge follow-up are essential for high-risk patients

Authors: Kleinveld, DJB; Curry, N; Levy, JH

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Intensive Care Medicine
• Volume: 49
• Issue: 9
• Pages: 1110-1113
• Publication date: 2023-05-13
• DOI: 10.1007/s00134-023-07089-6
• EISSN: 1432-1238
• ISSN: 0342-4642
• Language: English
• Keywords: Intensive care medicine; Coagulation; Internal medicine; Anesthesia; Pain medicine; Medicine; Perioperative; Anesthesiology