Bundled care in acute kidney injury in critically ill patients, a before-after educational intervention study
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RESEARCH ARTICLE
Open Access
Bundled care in acute kidney injury in critically ill patients, a before-after educational intervention study Jacqueline Koeze* , Iwan C. C. van der Horst, Renske Wiersema, Frederik Keus, Willem Dieperink, Eline G. M. Cox, Jan G. Zijlstra and Matijs van Meurs
Abstract Background: Acute kidney injury (AKI) often occurs in critically ill patients. AKI is associated with mortality and morbidity. Interventions focusing on the reduction of AKI are suggested by the Kidney Disease: Improving Global Outcomes guideline. We hypothesized that these educational interventions would improve outcome in patients admitted to the Intensive Care Unit (ICU). Methods: This was a pragmatic single-centre prospective observational before-after study design in an ICU in a tertiary referral hospital. All consecutive patients admitted to the ICU irrespective their illness were included. A ‘Save the Kidney’ (STK) bundle was encouraged via an educational intervention targeting health care providers. The educational STK bundle consisted of optimizing the fluid balance (based on urine output, serum lactate levels and/ or central venous oxygen saturation), discontinuation of diuretics, maintaining a mean arterial pressure of at least 65 mmHg with the potential use of vasopressors and critical evaluation of the indication and dose of nephrotoxic drugs. The primary outcome was the composite of mortality, renal replacement therapy (RRT), and progression of AKI. Secondary outcomes were the components of the composite outcome the severity of AKI, ICU length of stay and in-hospital mortality. Main results: The primary outcome occurred in 451 patients (33%) in the STK group versus 375 patients (29%) in the usual care group, relative risk (RR) 1.16, 95% confidence interval (CI) 1.03–1.3, p < 0.001. Secondary outcomes were, ICU mortality in 6.8% versus 5.6%, (RR 1.22, 95% CI 0.90–1.64, p = 0.068), RRT in 1.6% versus 3.6% (RR 0.46, 95% CI 0.28–0.76, p = 0.002), and AKI progression in 28% versus 24% (RR 1.18, 95% CI 1.04–1.35, p = 0.001). Conclusions: Providing education to uniformly apply an AKI care bundle, without measurement of the implementation in a non-selected ICU population, targeted at prevention of AKI progression was not beneficial. Keywords: AKI prevention, ICU, Care-bundle
* Correspondence: [email protected] Department of Critical Care, University of Groningen, University Medical Center Groningen, Postbus 30.001, 9700, RB, Groningen, The Netherlands © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not
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