Current opinion in critical care
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Curr Opin Crit Care · Dec 2022
ReviewQuality, safety, and implementation science in acute kidney care.
Quality and safety are important themes in acute kidney care (AKC). There have been many recent initiatives highlighting these aspects. However, for these to become part of clinical practice, a rigorous implementation science methodology must be followed. This review will present these practices and will highlight recent initiatives in acute kidney injury (AKI), kidney replacement therapy (KRT) and recovery from AKI. ⋯ Quality and safety continue to be important focuses in AKC. Although recent work have focused on initiatives to improve these themes, additional work is necessary to further develop these items as we strive to improve the care to patients with AKI.
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Curr Opin Crit Care · Dec 2022
ReviewFluid balance in pediatric critically ill patients (with and without kidney dysfunction).
The issues of fluid balance and fluid overload are currently considered crucial aspects of pediatric critically ill patients' care. ⋯ Current evidence on fluid balance in critically ill children is mainly based on retrospective and observational studies, and intense research should be recommended in this important field. In theory, active decongestion of patients with fluid overload could improve mortality and other clinical outcomes, but randomized trials or advanced pragmatic studies are needed to better understand the optimal timing, patient characteristics, and tools to achieve this.
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Curr Opin Crit Care · Dec 2022
ReviewOpportunities in digital health and electronic health records for acute kidney injury care.
The field of digital health is evolving rapidly with applications relevant to the prediction, detection and management of acute kidney injury (AKI). This review will summarize recent publications in these areas. ⋯ Further research is required to overcome barriers to the validation and implementation of ML models for AKI care. Simpler electronic systems within the electronic medical record can lead to improved care in some but not all settings, and careful consideration of local context and implementation strategy is recommended.
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The purpose of this review is to describe acute kidney injury (AKI) phenotypes in children. ⋯ Studies that further delineate these unique AKI subphenotypes are needed to better understand the impact of AKI in children. Further delineation of these phenotypes has both prognostic and therapeutic implications.
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Curr Opin Crit Care · Dec 2022
ReviewPragmatic platform trials to improve the outcome of patients with acute kidney injury.
There is an important need for improved diagnostic strategies and treatment among patients with acute kidney injury (AKI). Classical randomized clinical trials have generated relevant results in AKI but are associated with shortcomings, such as high costs and sometimes lack of generalizability. In this minireview, we discuss the value and limits of pragmatic trials and platform trials for AKI research. ⋯ Pragmatic and platform trials can provide clinical answers in 'real-life' settings, facilitate a significant sample size enrollment at a limited cost, and provide results that can have a faster implementation in clinical practice.