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PubMed1981

Role of respiratory assistance devices in endemic nosocomial pneumonia.

The role of respiratory assistance devices and techniques in the acquisition of endemic hospital-associated pneumonia was prospectively studied in 13,086 patients over 11 months. Of these, 914 (7 percent) had a respiratory assistance device for at least 24 hours. Cultures of respirator effluent air and nebulizer fluid (taken after 24 hours), tracheostomy sites and irrigating solutions and respirometers were obtained in the 144 of 914 patients who had a respiratory assistance device for at least 72 hours. There were 108 episodes of hospital-associated pneumonia in 107 patients (0.82 percent incidence). Gram-negative organisms were associated with 70 percent of these episodes and Strep. pneumoniae with 5 percent. The risk of hospital-associated pneumonia was 0.3 percent in patients without a respiratory assistance device (35 percent of total hospital-associated pneumonia) versus (1.3 percent with endotracheal tubes and respirators (11 percent of hospital-associated pneumonia), 25 percent with tracheostomy (12 percent of hospital-associated pneumonia) and 66 percent in patients with tracheostomy and a respirator (9 percent of hospital-associated pneumonia). No case of hospital-associated pneumonia occurred in patients on respirators less than 24 hours, but the risk of hospital-associated pneumonia increased significantly after the fifth day of therapy. None of the 63 cultures of nebulizer fluid was positive. Although positive cultures of respiratory effluent, tracheal suction fluid or respirometer were not predictive of the acquisition of hospital-associated pneumonia, nine of 107 patients acquired this infection after a previously positive culture of a respiratory assistance device, and in five instances with the same organism. Since contaminated respiratory assistance devices are rarely a direct cause of hospital-associated pneumonia, routine in-use monitoring of respiratory assistance devices does not appear warranted.

Cross Infection↗
PubMedDate not supplied

Icodextrin effluent leads to a greater proliferation than glucose effluent of human mesothelial cells studied ex vivo.

OBJECTIVE: To compare the effect of glucose (Glu) and icodextrin (Ico) dialysate on in vitro culture of mesothelial cells (MC) from peritoneal dialysis (PD) patients. DESIGN: Prospective, controlled comparative study on the effects of two PD solutions. SETTING: A tertiary-care public university hospital. PATIENTS: Sixteen PD patients regularly using Glu dialysate were asked to collect an 8-hour dwell peritoneal effluent on 2 different days, with an interval shorter than 7 days. In the first collection, 2.27% Glu solution and in the last, 7.5% Ico solution was infused. Human MC were isolated from the nocturnal peritoneal effluent bags and grown ex vivo. MAIN OUTCOME MEASURES: Mesothelial cell proliferative capacity ex vivo. RESULTS: Mesothelial cells were present in all patient dialysates except that of a single patient's Glu dialysate. The number of MC drained was similar with both solutions. After the initial culture reached confluence, MC were identified in 14 and 12 patients receiving Ico and Glu, respectively. However, in 1 patient using Ico and in 2 using Glu, the MC count at this stage was so low that further subculture could not be performed. Cells from Ico-derived solutions exhibited a higher degree of proliferation than cells from Glu-derived solutions. The morphology of MC was also different. Cells from drained effluent were typical in 11 patients using Glu solution in contrast with 14 patients using Ico. At confluence, the percentages of typical appearance were 50% and 92.9% (p < 0.05) in Glu and Ico respectively. CONCLUSIONS: Mesothelial cells taken from icodextrin effluent show a greater proliferation ex vivo than those taken from glucose effluent.

Cell Division↗
PubMed2003

[Hospital and environment: waste disposal].

Like all production units, hospitals produce waste and are responsible for waste disposal. Hospital waste is particular due to the environmental risks involved, particularly concerning infection, effluents, and radionucleide contamination. Management plans are required to meet environmental, hygiene and regulatory obligations and to define reference waste products. The first step is to optimize waste sorting, with proper definition of the different categories, adequate containers (collection stations, color-coded sacks), waste circuits, intermediate then central storage areas, and finally transfer to an incineration unit. Volume and delay to elimination must be carefully controlled. Elimination of drugs and related products is a second aspect: packaging, perfusion pouches, tubing, radiopharmaceutic agents. These later products are managed with non-sealed sources whose elimination depends on the radioactive period, requiring selective sorting and specific holding areas while radioactivity declines. Elimination of urine and excreta containing anti-cancer drugs or intravesical drugs, particularly coming from protected rooms using radioactive iodine is another aspect. There is also a marginal flow of unused or expired drugs. For a health establishment, elimination of drugs is not included as part of waste disposal. This requires establishing a specific circuit with selective sorting and carefully applied safety regulations. Market orders for collecting and handling hospital wastes must be implemented in compliance with the rules of Public Health Tenders.

Antineoplastic Agents↗
PubMedDate not supplied

Diagnostic value of effluent endotoxin level in gram-negative peritonitis in CAPD patients.

OBJECTIVE: To evaluate the diagnostic usefulness of effluent endotoxin by Limulus amoebocyte lysate (LAL) assay in gram-negative peritonitis patients on continuous ambulatory peritoneal dialysis (CAPD) therapy. DESIGN: Prospective study with patients serving as their own controls. Standard microbiologic work up and endotoxin analysis of effluents (night dwell) were done during the pre- and posttreatment phases. SETTING: Specimens from three teaching hospitals were processed and tested at a common center. Patients were left for treatment at their respective centers without intervention. PATIENTS: 32 clinical peritonitis and 40 infection-free CAPD patients were studied. RESULTS: 75% (n = 24) of cultures were positive: 41.6% (n = 10) gram-negative and 58.4% (n = 14) gram-positive bacteria. Effluents of pre- and posttreated gram-negative cultures had endotoxin levels of 1.53 +/- 0.169 and 0.214 +/- 0.085 endotoxin units (EU)/mL, respectively (p < 0.0001); pre- and posttreated gram-positive levels of 0.102 +/- 0.06 and 0.122 +/- 0.052 EU/mL, respectively (p > 0.05); pre- and posttreated culture-negative peritonitis levels of 0.110 +/- 6.025 and 0.087 +/- 0.031 EU/mL, respectively (p > 0.05); peritonitis-free effluents contained 0.117 +/- 0.079 EU/mL. The diagnostic specificity and the sensitivity of LAL assay were 100% and 98.2% respectively. CONCLUSION: Where initial microbiological work-up cannot demonstrate a pathogen, effluent endotoxin determined by quantitative LAL assay is a useful marker for diagnosis and management, within safe time limits, of gram-negative peritonitis in CAPD patients.

Adult↗
PubMed2002

Does gender difference influence outcome?

BACKGROUND: Recent laboratory studies have demonstrated that immune responses differ between male and female rodents, and some clinical studies have suggested gender differences regarding incidence and mortality from sepsis. The differences appear because of both deleterious testosterone and beneficial estrogen effects; clinical trials of testosterone blockage and/or estrogen administration for male subjects have been suggested. We evaluated the effect of gender on various outcomes in trauma patients. METHODS: Trauma patients over a 52-month period were identified from the trauma registry. Early deaths were excluded. Outcomes included mortality, pneumonia (> or = 10 colony-forming units/mL in bronchoalveolar lavage effluent), acute respiratory distress syndrome, bacteremia, ventilator days, and intensive care unit and hospital length of stay. Patients were stratified by injury mechanism, gender, age (assuming women < or = 40 were premenopausal and those > 50 were postmenopausal), and injury severity. RESULTS: There were 18,133 patients identified, and 544 were excluded because of early death. There were 12,756 (73%) men and 4,833 (27%) women. There were no outcome differences after penetrating injury with respect to gender and age group. There was a survival advantage for women < or = 40 in the Injury Severity Score 16 to 24 group, but these patients had statistically less severe injury. Overall, men tended to have more infectious complications, but women had lower survival in the face of infection. Logistic regression did not identify gender as an independent predictor of mortality. CONCLUSION: Although there was a survival advantage for women in subgroup analysis, there was no overall difference in mortality. Women with pneumonia, however, had a higher mortality than men. Further understanding of potential mechanisms is necessary before hormonal manipulation studies.

Adult↗
PubMed2000

Childhood cancers, birthplaces, incinerators and landfill sites.

BACKGROUND: In all, 70 municipal incinerators, 307 hospital incinerators and 460 toxic-waste landfill sites in Great Britain were examined for evidence of effluents causing childhood cancers. Municipal incinerators had previously shown significant excesses of adult cancers within 7.5 and 3.0 km. The relative risks for adults had been marginal and an analysis of childhood cancers seemed to offer a more sensitive approach. METHODS: A newly developed technique of analysis compares distances from suspect sources to the birth addresses and to the death addresses of cancer-children who had moved house. A localized hazard, effective at only one of these times, must be preferentially associated with the corresponding address. This creates an asymmetry of migrations towards or away from age-restricted effective sources. RESULTS: The child-cancer/leukaemia data showed no systematic migration-asymmetries around toxic-waste landfill sites; but showed highly significant excesses of migrations away from birthplaces close to municipal incinerators. Relative risks within 5.0 km of these sites were about 2:1. Hospital incinerators gave analogous results. The ratios greatly exceed findings around 'non-combustion' urban sites. CONCLUSIONS: Because of their locations, the specific effects of the municipal incinerators could not be separated clearly from those of adjacent industrial sources of combustion-effluents. Both were probably carcinogenic. Landfill waste sites showed no such effect.

Adolescent↗
PubMed2005

Effects of meconium aspiration in isolated perfused rat lungs.

Our objective was to study meconium-induced lung injury in isolated perfused rat lungs exposed to anoxia. Our working hypothesis was that meconium-induced lung injury is independent of preexisting hypoxia, and that hypoxia will increase severity of lung injury observed after meconium aspiration. We compared five different groups of animals (n = 5) for pulmonary arterial pressure (PAP), weight lung changes, and TNFalpha expression. Group I had lungs instilled with 4 ml of normal saline. Group II had lungs exposed to 5 min of anoxia. Group III had lungs instilled with 4 ml of 30% filtered human meconium. Group IV had lungs exposed to 5 min of anoxia and then instilled with 4 ml of 30% filtered human meconium. Group V had lungs instilled with 4 ml of 30% unfiltered human meconium. Our subjects were adult Sprague-Dawley rats. The isolated rat lung model was prepared according to Levey and Gast (J Appl Physiol 1966;21:313-316). Lungs were ventilated with room air. Anoxia was caused by the use of N(2). The pulmonary artery was cannulated, and pulmonary arterial pressure and lung weight were measured. Lung weight and pulmonary arterial pressure were monitored for 120 min, and TNFalpha levels were measured in effluent at 15, 30, 60, and 120 min. Experiments were done at the Michael Reese Hospital (Chicago, IL). At the end of the experiment, PAP reached its highest values in group V (10.0 +/- 1.7 mmHg). Final PAPs in groups I-IV were: 4.85 +/- 0.3, 4.99 +/- 0.4, 5.93 +/- 0.3, and 7.25 +/- 0.51 mmHg, respectively). Lung wet weight increased significantly only in groups IV and V vs. group I; at 120 min, they were: 0.96 +/- 0.3 g, P < 0.01, and 1.5 g +/- 0.2 g, P < 0.01, respectively. TNFalpha levels did not change significantly over time in group I. TNFalpha is a marker as well as proprietor of pulmonary inflammatory response. TNFalpha reached its highest levels in groups IV and V: 595 and 753 pg/ml at 120 min, respectively. In conclusion, a short episode of anoxia prior to meconium aspiration may increase lung sensitivity to meconium-induced lung injury. This effect may be moderated by the TNFalpha present in the pulmonary circulation.

Animals↗
PubMed1987

Effect of water temperature on bacterial killing in laundry.

The increasing cost of energy directed our attention to testing the feasibility of low temperature washing. Hospital laundries use formulated chemicals at high temperature wash waters of 66 degrees C. Wash water effluents and fabric bacterial counts of heavily soiled linen were correlated with alkalinity and temperature measurements to investigate the bacterial killing action of hot and cold wash formulas. Terry towels were found to be contaminated with 10(7) to 10(9) organisms per 100 cm2 at the beginning of the washing process. The most common gram-negative rods found were Klebsiella, Enterobacter and Serratia species. Staphylococci were the predominant gram-positives. Both cold and hot water washing including the bleach cycle reduced bacterial counts in fabric by 3 log10. Similarly wash water cfu/mL mL declined 3 to 4 log10. A further 0.5 to 1.0 log10 reduction was effected in the 93.3 degrees C drying cycle. Low temperature wash formulas were comparable to high temperature laundry with respect to bacterial counts and species. Cold water formulas at 31.1 degrees C offer an alternative method to reduce energy consumption and maintain bacteriological and esthetic linen quality.

Bacteria↗
PubMed2002

Anthropogenic Gd in surface water, drainage system, and the water supply of the city of Prague, Czech Republic.

The anthropogenic Gd (Gdant) loads and fluxes of surface- and groundwaters, and of effluents from sewage treatment plants of Prague and its surroundings, have been determined. While passing Prague the Gdant load of the Vltava river increases from 4.5 to 19.2 nmol/m3, which is caused by the effluents of the central sewage treatment plant with a 6 day average of 250 nmol/m3. The Berounka river with its enhanced content doubles the Gdant flux of the Vltava river before entering Prague. All minor creeks draining Prague add less than 3% of the Gdant load in the Vltava river downstream of Prague. The 11-days average of the amount of the administered Gd complexes of the gadopentetic acid (Gd-DTPA), gadobenic acid, and other compounds in Prague's hospitals (22 g-Gdant/d) exceeds the 6 days average of 15 g-Gdant/d in the effluent of the central sewage treatment plant. This strongly indicates uncontrolled losses of sewage from sewers to the groundwater.

Cities↗
PubMed1973

Drug resistance of coliform bacteria in hospital and city sewage.

The number and properties of drug-resistant coliform bacteria in hospital and city sewage were compared. There was little difference in the counts of organisms with nontransferable resistance to one or more of 13 commonly used drugs. An average of 26% of coliforms in hospital waste water had transferable resistance to at least one of the drugs ampicillin, chloramphenicol, streptomycin, sulfonamide, or tetracycline as compared to an average of 4% in city sewage. R(+) bacteria in the hospital discharge were also resistant to a broader spectrum of drugs than those in city sewage. In both effluents, the occurrence of fecal Escherichia coli among R(+) coliforms was twice as high as among coliforms with nontransferable resistance. Resistance was transferable to Salmonella typhi, and such drug-resistant pathogens in the water environment could be of particular concern. The significance of the results with regard to environmental pollution with R(+) bacteria and the dissemination of these organisms is discussed.

Anti-Bacterial Agents↗
PubMed2004

Impact of detection of bacterial endotoxin in menstrual effluent on the pregnancy rate in in vitro fertilization and embryo transfer.

OBJECTIVE: To examine whether bacterial endotoxin is detectable in menstrual effluent and to analyze a possible association between endotoxin levels and a pregnancy rate after IVF-ET. DESIGN: Prospective observational study. SETTING: University hospital. PATIENT(S): Thirty-eight infertile women undergoing endotoxin assay and IVF-ET. INTERVENTION(S): Endotoxin was assayed by the limulus amoebocyte lysate test. MAIN OUTCOME MEASURE(S): Levels of bacterial endotoxin and a pregnancy rate. RESULT(S): In 38 samples of menstrual effluent taken from 38 women, bacterial endotoxin was detected with a range of 7.1 to >1,000 pg/mL in 37 samples and was not detected in 1 sample. After IVF-ET, pregnancy occurred in 9 of the 38 women. The mean (+/- SD) endotoxin level in these 9 pregnant women was 71.3 +/- 52.5 pg/mL and was significantly lower compared with >236.2 +/- 333.6 pg/mL in the 29 nonpregnant women. All pregnancies occurred in 28 women with an endotoxin level of </=200 pg/mL, whereas no pregnancies occurred in 10 women with an endotoxin level of >200 pg/mL, producing the significantly higher pregnancy rate in the former group than in the latter. CONCLUSION(S): Bacterial endotoxin was detectable in menstrual effluent from infertile women. The pregnancy rate after IVF-ET was significantly higher in women with an endotoxin level of </=200 pg/mL than in women with an endotoxin level of >200.0 pg/mL.

Adult↗
PubMed2001

Is postoperative blood loss, loss of blood? A pilot study in cardiac surgical patients.

The effect of estimating the blood balance using changes in erythrocyte volumes (EVs) instead of the routinely used changes in haematocrit values was studied in 20 patients scheduled for cardiac surgery. We determined the mean haematocrit of the effluent from the postoperative thoracic drainage system at various time intervals. These data were used to more accurately calculate the blood balance. From 8h after surgery onwards, the haematocrit in the thoracic effluent was less than 10%. Total loss of thoracic effluent until 24h after removal of the aortic crossclamp (ACC) was 1,735 +/- 803 ml. Calculated blood loss until 24 h after ACC was only 58% of the total thoracic effluent. Plasma volumes in these patients increased from preoperative values of 2,505 +/- 499ml at admission to the hospital to maximum levels of 4,969 +/- 1,027 ml at 12 h after ACC (p < 0.05). Blood volume rose to 159% of the preoperative value at 12 h after ACC, whereas the EV remained relatively stable, decreasing to 95% of the preoperative value at 4 h after ACC and increasing to 107% of the baseline value at 24 h after ACC. In the meantime, patient haematocrit decreased to 78% of the reference value at the time of induction of anaesthesia at 4 h after ACC and then increased to 84% at 24 h after ACC. Thus, the use of patient haematocrit considerably overestimates blood loss. The EV appears to be a more appropiate variable than haematocrit in monitoring the blood balance in cardiac surgical patients. Future studies should reveal whether the EV is practicable in daily clinical practice.

Aged↗
PubMedDate not supplied

IgG subclasses in CAPD patients.

OBJECTIVE: To make a comparison of serum levels of immunoglobulin G (IgG) subclasses in adult continuous ambulatory peritoneal dialysis (CAPD) patients with those in age- and sex-matched hemodialysis patients and healthy volunteers, and to analyze the contribution of removal of these proteins in peritoneal effluent to their plasma values. DESIGN: A cross-sectional study. SETTING: A renal unit of a university hospital. PATIENTS: Twenty-three CAPD patients, 21 hemodialysis patients, and 21 healthy volunteers. Peritoneal transport studies were done in 8 of the 23 CAPD patients. METHODS: IgG subclasses were measured in serum by nephelometry. For the peritoneal transport studies an ELISA method on ethylenediamine tetracetic acid plasma was used. The same method was used in seven-to-ten-fold concentrated peritoneal dialysate. RESULTS: CAPD patients had lower IgG2 and IgG4 levels than hemodialysis patients and healthy volunteers (p < 0.01). IgG2 values below 1.5 g/L were present in 43% of the CAPD patients (p < 0.001 compared to healthy volunteers). Peritonitis incidence was not different between CAPD patients with low or normal IgG2 plasma levels. Peritoneal clearance of IgG3 was lower than that of the other subclasses. Evidence was obtained for a depressed synthesis of IgG2 and IgG4 in CAPD patients. The hypothesis that interleukin-2 may be involved in the low synthesis rate of IgG2 is discussed. CONCLUSION: Low serum IgG2 and IgG4 levels are present in stable, adult CAPD patients. These were not caused by increased peritoneal loss, but by decreased synthesis.

Adult↗
PubMed1984

Swan thyroid glands and river algae as indicators of iodine-125 and iodine-131 in the River Trent and its tributaries.

Some mute swans have been found to have higher levels of radio-iodine in their thyroids than farm and wildlife animals. In the East Midlands of the U.K., elevated levels were confined to swans inhabiting major rivers like the Trent and Soar where the highest values occurred in thyroids collected downstream from sewage and water reclamation works. Comparing the concentrations of 125I and 131I in blanket weed, which is a food source of the swan, and river water samples collected from above, below and in such effluents, showed that radio-iodine enters the river via these routes. The environmental pathway is sewage effluent--(water reclamation)--river water--river weed--swan. The radioactivity originates from the widespread use of radio-iodine in hospitals and analytical laboratories where much of the liquid and soluble waste is discarded into the sewage drain system. With a simple counting assembly consisting of a heavily shielded thin NaI(Tl) crystal detector attached to a 2-channel scaler-timer it was possible to check large numbers of swan thyroid glands. Although relatively high count rates were frequently obtained the levels of radio-iodine in thyroids were too low to affect the health and well-being of the swan.

Animals↗
PubMed1992

Presence of human immunodeficiency virus nucleic acids in wastewater and their detection by polymerase chain reaction.

The human immunodeficiency virus type 1 (HIV-1) released by infected individuals or present in human and hospital wastes can potentially cause contamination problems. The presence of HIV-1 was investigated in 16 environmental samples, including raw wastewater, sludge, final effluent, soil, and pond water, collected from different locations. A method was developed to extract total nucleic acids in intact form directly from the raw samples or from the viral concentrates of the raw samples. The isolated nucleic acids were analyzed for the presence of HIV-1 by using in vitro amplification of the target sequences by the polymerase chain reaction (PCR) method. HIV-1-specific proviral DNA and viral RNA were detected in the extracted nucleic acids obtained from three wastewater samples by this method. The specificity of the PCR-amplified products was determined by Southern blot hybridization with an HIV-1-specific oligonucleotide probe, SK19. The isolated nucleic acids from wastewater samples were also screened for the presence of poliovirus type 1, representing a commonly found enteric virus, and simian immunodeficiency virus, representing, presumably, rare viruses. While poliovirus type 1 viral RNA was found in all of the wastewater samples, none of the samples yielded a simian immunodeficiency virus-specific product. No PCR-amplified product was yielded when wastewater samples were directly used for the detection of HIV-1 and poliovirus type 1. The wastewater constituents appeared to be inhibitory to the enzymes reverse transcriptase and DNA polymerase.(ABSTRACT TRUNCATED AT 250 WORDS)

Base Sequence↗
PubMed2002

Dosing patterns for continuous renal replacement therapy at a large academic medical center in the United States.

PURPOSE: We sought to retrospectively review the dosing patterns of continuous renal replacement therapy (CRRT) in patients with acute renal failure (ARF) and determine their actual delivered dosage of CRRT. MATERIALS AND METHODS: Computerized records of patients (n = 115) who received CRRT for ARF at a single, large, academic, tertiary care hospital from September 1, 1999 through August 31, 2000 were reviewed. The delivered dose of CRRT for each patient/day was calculated from the hourly effluent flow rate, the patient's weight, and the duration (in hours) of CRRT for that day. A mean effluent flow rate (in L/h) for each patient was then calculated. RESULTS: The average number of hours/day on CRRT was 16.1 +/- 3.53 (mean +/- SD), with a mean flow rate (averaged over 24 h) of 1.36 +/- 0.31 L/h. The mean CRRT dose prescribed for these patients was 24.46 +/- 6.73 mL/Kg/h, but the mean dose delivered was only 16.55 +/- 5.41 mL/Kg/h (68% of the prescribed dose, P <.000001). CONCLUSIONS: Many patients are prescribed low doses of CRRT. Furthermore, the dose delivered is considerably lower than that prescribed. Methods and procedures to extend CRRT system life may improve the dose delivery.

Academic Medical Centers↗
PubMed1993

Uptake of glucose during continuous arteriovenous hemofiltration.

OBJECTIVE: To quantify glucose balance related to continuous arteriovenous hemofiltration (CAVH) when a glucose-rich replacement fluid is used for the plasma ultrafiltrate removed. DESIGN: Prospective, nonintervention study. SETTING: Medical/surgical and cardiac surgical intensive care units of a university hospital. PATIENTS: Critically ill patients (n = 20) with acute oliguric renal failure undergoing CAVH. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Timed collections of CAVH effluent were analyzed and other observations were made. Serum creatinine and blood urea nitrogen concentrations decreased substantially during CAVH in each patient. The mean measured glucose concentration of the replacement fluid (Dianeal 1.5%) was 1.40 +/- 0.11 (SD) g/dL (77 +/- 6 mmol/L) and rate of infusion was 1.39 +/- 0.43 L/hr. Effluent volume was 1.51 +/- 0.49 L/hr and glucose was 0.47 +/- 0.10 g/dL (26 +/- 5 mmol/L). The glucose content of the replacement fluid infused was consistently and substantially greater than that value of the effluent removed during the same period. Thus, the average net glucose uptake in relation to the CAVH circuit was 11.9 +/- 3.1 g/hr (range 4.3 to 17.6). Serum glucose concentrations increased in each patient with initiation of CAVH (from 135 +/- 44 to 278 +/- 80 mg/dL [7.4 +/- 2.4 to 15.3 +/- 4.4 mmol/L]; p < .001). Negative fluid balance achieved during CAVH was approximately 100 mL/hr. CONCLUSIONS: CAVH using predilution with replacement fluid is effective in managing uremia and fluid overload in critically ill patients. The use of a glucose-rich replacement fluid is accompanied by the net uptake of large amounts of glucose, approaching 300 g/day on average in our patients and representing a major exogenous calorie source. This finding has important implications for the metabolic management of critically ill patients during CAVH and should be taken into account in prescribing their nutritional support.

Acute Kidney Injury↗