Browsing by Author "Erickson, Stephen"

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    Admission Serum Magnesium Levels Predict the Risk of Acute Respiratory Failure Requiring Mechanical Ventilation in Hospitalized Patients
    (Chest, 2015-10-01) Srivali, Narat; Thongprayoon, Charat; Thongprayoon, Charat; Erickson, Stephen
    PURPOSE: The association between admission serum magnesium (Mg) levels and risk of acute respiratory failure (ARF) requiring mechanical ventilation in hospitalized patients is limited. The aim of this study was to assess the risk of developing ARF in all hospitalized patients with various admission Mg levels. METHODS: This is a single-center retrospective study conducted at a tertiary referral hospital. All hospitalized adult patients who had admission Mg available from January to December 2013 were analyzed in this study. Admission Mg was categorized based on its distribution into six groups (less than 1.5, 1.5 to 1.7, 1.7 to 1.9, 1.9 to 2.1, 2.1 to 2.3, and greater than 2.3 mg/dL). The primary outcome was in-hospital ARF requiring mechanical ventilation occurring after hospital admission. Logistic regression analysis was performed to obtain the odds ratio of ARF of various admission Mg levels using Mg of 1.7 to 1.9 mg/dL as the reference group. RESULTS: Of 9,780 patients enrolled, ARF occurred in 619 patients (6.3%). The lowest incidence of ARF was when serum Mg within 1.7-1.9 mg/dL. A U-shaped curve emerged demonstrating higher incidences of ARF associated with both hypoMg (<1.7) and hyperMg (>1.9). After adjusting for potential confounders, both hypoMg (<1.5 mg/dL) and hyperMg (>2.3 mg/dL) were associated with an increased risk of developing ARF requiring mechanical ventilation with odds ratios of 1.69 (95% CI 1.19-2.36) and 1.40 (95% CI 1.02-1.91), respectively. CONCLUSIONS: Both admission hypoMg and hyperMg were associated with an increased risk for in-hospital ARF requiring mechanical ventilation. CLINICAL IMPLICATIONS: Our study demonstrated that admission Mg level was correlated with the incidence of ARF requiring mechanical ventilation during hospitalization so physician should be awared and correct Mg level accordingly.
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    HYDRATION FOR CONTRAST-INDUCED ACUTE KIDNEY INJURY PREVENTION A META-ANALYSIS
    (Critical Care Medicine, 2014-12-01) Srivali, Narat; Cheungpasitporn, Wisit; Charat, Thongprayoon; Edmonds, Peter; O’Corragain, Oisin; Kittanamongkolchai, Wonngarm; Brabec, Brady; Erickson, Stephen
    Learning Objectives: The reports on efficacy of oral hydration compared to intravenous hydration for the prevention of contrast-induced acute kidney injury (CIAKI) in radiological procedures and cardiac catheterization remains controversial. The objective of this meta-analysis was to assess the efficacy of these hydration regimens for prevention of CIAKI. Methods: Comprehensive literature searches for randomized controlled trials (RCTs) of outpatient oral hydration treatment was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception until July 4th, 2014. Primary outcome was the incidence of CIAKI. Results: Three prospective RCTs were included in our analysis. Of 242 patients undergoing procedures with contrast exposures, 22 patients (9%) had CIAKI. These 3 RCTs, however, included only patients with relatively normal kidney function to CKD stage 3 and excluded those who had contrast exposure for urgent indications. There was no significant increased risk of CIAKI in oral fluid regimen group compared to IV fluid regimen group (RR = 1.83, 95% CI = 0.41–8.21). Conclusions: According to our analysis, there is no evidence that oral fluid regimen is associated with more risk of CIAKI in patients with contrast exposures compared to IV fluid regimen. This finding suggests that the oral fluid regimen is a possible treatment option for CIAKI prevention in non-urgent procedures in patients with normal to moderately reduced kidney function.