Browsing by Author "Kashani, Kianoush"
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Item Open Access CHANGING TRENDS IN THE USE OF VASOPRESSORS IN INTENSIVE CARE UNIT: A 7-YEAR STUDY(Critical Care Medicine, 2014-12) Srivali, Narat; Thongprayoon, Charat; Kittanamongkolchai, Wonngarm; Cheungpasitporn, Wisit; Erdogan, Aysen; Carrera, Perliveh; Kashani, KianoushLearning Objectives: The use of vasopressors was common in intensive care unit (ICU). Due to the lack of conclusive evidence in superiority in efficacy among various types of vasopressors, the choice of vasopressor use mainly depends on the physician preference. This study aims to describe the prevalence of vasopressor use and the trend in the use of each vasopressor medication in ICU over the past 7 years. Methods: This is a descriptive study conducted at a tertiary referral hospital. All ICU admissions, including both medical and surgical ICU, at our institution between January 2007 and December 2013 were included in this study. The use of vasopressors within given ICU day (12.00 am – 11.59 pm) during ICU stay was reviewed. Vasopressors were defined as the continuous intravenous administration of norepinephrine, epinephrine, dopamine, phenylephrine, or vasopressin regardless of duration and dosage. Results: A total of 52410 unique patients had 72005 ICU admissions in the course of study, (272271 patient*ICU day). Vasopressors were used in 17767 (24.7%) ICU admissions and on 53898 (19.8%) patient*ICU day, resulting in a total of 76564 vasopressor day. Vasopressin was used on 21955 (41%), epinephrine on 20958 (39%), norepinephrine on 17919 (33%), dopamine on 8636 (16%) and phenylephrine on 7096 (13%) patient*ICU day. Over 2007-2013, there was an upward trend in the use of norepinephrine (the proportion of ICU day on norepinephrine over total ICU day with vasopressor 0.24 in year 2007 to 0.45 in year 2013), and a downward trend in phenylephrine (the proportion of ICU day on phenylephrine over total ICU day with vasopressor 0.20 in year 2007 to 0.10 in year 2013). There was no specific trend in the usage of vasopressin, epinephrine, and dopamine. Conclusions: The vasopressors were used in about one fourth of ICU admission and about one fifth of ICU days. Vasopressin is the most commonly used vasopressor. The use of norepinephrine is in upward trajectory.Item Open Access Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis.(Journal of clinical medicine, 2019-07) Thongprayoon, Charat; Cheungpasitporn, Wisit; Lertjitbanjong, Ploypin; Aeddula, Narothama Reddy; Bathini, Tarun; Watthanasuntorn, Kanramon; Srivali, Narat; Mao, Michael A; Kashani, KianoushAlthough acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%-72.4%) and 44.9% (95%CI: 40.8%-49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87-4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21-4.99). There was no publication bias as evaluated by the funnel plot and Egger's regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.