دورية أكاديمية
أعرض في EDS

Neurological Impairment in Critically Ill Patients on Dialysis: Research Letter for the INCOGNITO-AKI Feasibility Study.

التفاصيل البيبلوغرافية
العنوان: Neurological Impairment in Critically Ill Patients on Dialysis: Research Letter for the INCOGNITO-AKI Feasibility Study.
المؤلفون: Jawa NA; Centre for Neuroscience Studies, School of Medicine, Queen's Health Sciences, Queen's University, Kingston, ON, Canada., Silver SA; Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada., Holden RM; Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada., Scott SH; Centre for Neuroscience Studies, School of Medicine, Queen's Health Sciences, Queen's University, Kingston, ON, Canada.; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada., Day AG; Kingston General Health Research Institute, Kingston, ON, Canada.; Department of Public Health Sciences, Queen's University, Kingston, ON, Canada., Norman PA; Kingston General Health Research Institute, Kingston, ON, Canada., Kwan BYM; Department of Diagnostic Radiology, Queen's University, Kingston, ON, Canada., Maslove DM; Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.; Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada., Muscedere J; Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.; Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada., Boyd JG; Centre for Neuroscience Studies, School of Medicine, Queen's Health Sciences, Queen's University, Kingston, ON, Canada.; Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.; Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada.; Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada.
المصدر: Canadian journal of kidney health and disease [Can J Kidney Health Dis] 2023 Aug 24; Vol. 10, pp. 20543581231192743. Date of Electronic Publication: 2023 Aug 24 (Print Publication: 2023).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: SAGE Publications Country of Publication: England NLM ID: 101640242 Publication Model: eCollection Cited Medium: Print ISSN: 2054-3581 (Print) Linking ISSN: 20543581 NLM ISO Abbreviation: Can J Kidney Health Dis Subsets: PubMed not MEDLINE
أسماء مطبوعة: Publication: London : SAGE Publications
Original Publication: London : BioMed Central, 2014-
مستخلص: Background: Acute kidney injury (AKI) resulting in kidney replacement therapy is rising among critically ill adults. Long-term kidney replacement therapy and critical illness are independently linked to acute and prolonged cognitive impairment, and structural brain pathology. Poor regional cerebral oxygenation (rSO 2 ) may be a contributing factor.
Objective: To assess the feasibility of testing the association between intradialytic rSO 2 and acute and long-term neurological outcomes.
Design: Longitudinal observational study.
Setting and Participants: We enrolled patients initiating continuous kidney replacement therapy or intermittent hemodialysis in the Kingston Health Sciences Centre (KHSC) Intensive Care Unit (ICU).
Measurements and Methods: rSO 2 was monitored during the first 72 hours of continuous kidney replacement therapy or throughout each intermittent hemodialysis session. We measured acute neurological impairment by daily delirium screening and long-term neurocognitive outcomes using the Kinarm robot, Repeatable Battery for the Assessment of Neuropsychological Status, and brain magnetic resonance imaging.
Results: Of 484 ICU patients, 26 met the screening criteria. Two declined, and 13 met at least one exclusion criteria. Eleven patients were enrolled. Eight died in ICU, one died 2 months after discharge, and one declined follow-up. Data capture rates were high: rSO 2 /vitals (91.3%), and delirium screening and demographics (100%). Longitudinal testing was completed in 50% (1 of 2) of survivors.
Limitations: Enrollment was low due to a variety of factors, limiting our ability to evaluate long-term outcomes.
Conclusion: rSO 2 and delirium data collection is feasible in critically ill patients undergoing kidney replacement therapy; high mortality limits follow-up.
Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: S.H.S. is cofounder and CSO of Kinarm (Kingston, Ontario, Canada), which commercializes the Kinarm End-Point Lab robotic technology used in the present study. S.A.S. has received speaking fees from Baxter Canada. N.A.J., R.M.H., A.G.D., P.A.N., B.Y.M.K., D.M.M., J.M., and J.G.B. have no conflicts of interest to declare.
(© The Author(s) 2023.)
فهرسة مساهمة: Keywords: cerebral oxygenation; critical illness; kidney replacement therapy; neurocognitive impairment; neuroimaging
Local Abstract: [Publisher, French] L’insuffisance rénale aiguë (IRA) menant à une thérapie de remplacement rénal est en augmentation chez les adultes aux soins intensifs. Un séjour aux soins intensifs et la thérapie de remplacement rénal à long terme sont indépendamment liés à des déficits cognitifs aigus et prolongés ainsi qu’à des pathologies structurelles du cerveau. La faible saturation régionale du cerveau en oxygène (rSO2) pourrait être un facteur contributif. [Publisher, French] Évaluer la possibilité de tester l’association entre la rSO 2 intradialytique et les résultats neurologiques aigus et chroniques. [Publisher, French] Étude observationnelle longitudinale. [Publisher, French] Nous avons recruté des patients qui entamaient une thérapie de remplacement rénal en continu ou une hémodialyse intermittente à l’unité des soins intensifs (USI) du Kingston Health Sciences Centre (KHSC). [Publisher, French] La rSO2 a été surveillée pendant les 72 premières heures de thérapie de remplacement rénal en continu, ou tout au long de chaque séance d’hémodialyse intermittente. Nous avons mesuré les déficits neurologiques aigus par un dépistage quotidien du délirium et les atteintes neurocognitives à long terme à l’aide du robot Kinarm, de la Repeatable Battery for the Assessment of Neuropsychological Status et de l’imagerie par résonance magnétique cérébrale. [Publisher, French] Sur les 484 patients hospitalisés à l’USI, 26 répondaient aux critères de sélection. Deux ont refusé de participer à l’étude et treize satisfaisaient à au moins un critère d’exclusion. Onze patients ont été inclus à l’étude. Huit patients sont décédés à l’USI, un est décédé deux mois après sa sortie de l’hôpital et un a refusé le suivi. Les taux de saisie des données étaient élevés: rSO2 et paramètres vitaux (91,3 %), dépistage du délirium et démographie (100 %). Des tests longitudinaux ont été effectués chez 50 % (1 de 2) des survivants. [Publisher, French] Le taux d’inscription était faible en raison de divers facteurs, ce qui a limité notre capacité à évaluer les résultats à long terme. [Publisher, French] Il est possible de collecter des données sur la rSO2 et le délirium chez les patients de soins intensifs qui suivent une thérapie de remplacement rénal; un taux de mortalité élevé a limité le suivi. [Publisher, French] clinicaltrials.gov, registration number NCT04722939.
سلسلة جزيئية: ClinicalTrials.gov NCT04722939
تواريخ الأحداث: Date Created: 20230830 Latest Revision: 20230918
رمز التحديث: 20230919
مُعرف محوري في PubMed: PMC10461308
DOI: 10.1177/20543581231192743
PMID: 37644980
قاعدة البيانات: MEDLINE
الوصف
تدمد:2054-3581
DOI:10.1177/20543581231192743