nach oben

Intensive Care Medicine

Erschienen in:

12.06.2020 | COVID-19 | Narrative Review Zur Zeit gratis

Acute kidney injury in critically ill patients with COVID-19

verfasst von: Paul Gabarre, Guillaume Dumas, Thibault Dupont, Michael Darmon, Elie Azoulay, Lara Zafrani

Erschienen in: Intensive Care Medicine | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

Acute kidney injury (AKI) has been reported in up to 25% of critically-ill patients with SARS-CoV-2 infection, especially in those with underlying comorbidities. AKI is associated with high mortality rates in this setting, especially when renal replacement therapy is required. Several studies have highlighted changes in urinary sediment, including proteinuria and hematuria, and evidence of urinary SARS-CoV-2 excretion, suggesting the presence of a renal reservoir for the virus. The pathophysiology of COVID-19 associated AKI could be related to unspecific mechanisms but also to COVID-specific mechanisms such as direct cellular injury resulting from viral entry through the receptor (ACE2) which is highly expressed in the kidney, an imbalanced renin–angotensin–aldosteron system, pro-inflammatory cytokines elicited by the viral infection and thrombotic events. Non-specific mechanisms include haemodynamic alterations, right heart failure, high levels of PEEP in patients requiring mechanical ventilation, hypovolemia, administration of nephrotoxic drugs and nosocomial sepsis. To date, there is no specific treatment for COVID-19 induced AKI. A number of investigational agents are being explored for antiviral/immunomodulatory treatment of COVID-19 and their impact on AKI is still unknown. Indications, timing and modalities of renal replacement therapy currently rely on non-specific data focusing on patients with sepsis. Further studies focusing on AKI in COVID-19 patients are urgently warranted in order to predict the risk of AKI, to identify the exact mechanisms of renal injury and to suggest targeted interventions.

Nur mit Berechtigung zugänglich

Peerapornratana S, Manrique-Caballero CL, Gómez H, Kellum JA (2019) Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int 96:1083–1099. https://doi.org/10.1016/j.kint.2019.05.026 CrossRefPubMedPubMedCentral

Grasselli G, Zangrillo A, Zanella A et al (2020) Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. https://doi.org/10.1001/jama.2020.5394 CrossRefPubMedPubMedCentral

Bhatraju PK, Ghassemieh BJ, Nichols M et al (2020) Covid-19 in critically Ill patients in the seattle region–case series. N Engl J Med. https://doi.org/10.1056/NEJMoa2004500 CrossRefPubMedPubMedCentral

Arentz M, Yim E, Klaff L et al (2020) Characteristics and outcomes of 21 critically Ill patients with COVID-19 in Washington State. JAMA. https://doi.org/10.1001/jama.2020.4326 CrossRefPubMedPubMedCentral

Guan W-J, Ni Z-Y, Hu Y et al (2020) Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. https://doi.org/10.1056/NEJMoa2002032 CrossRefPubMedPubMedCentral

Wang L, Li X, Chen H et al (2020) Coronavirus disease 19 infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China. AJN. https://doi.org/10.1159/000507471 CrossRef

Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497–506. https://doi.org/10.1016/S0140-6736(20)30183-5 CrossRefPubMedPubMedCentral

Wen C, Yali Q, Zirui G et al (2020) Prevalence of acute kidney injury in severe and critical COVID-19 patients in Wuhan, China. Social Science Research Network, Rochester, NY

Cheng Y, Luo R, Wang K et al (2020) Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. https://doi.org/10.1016/j.kint.2020.03.005 CrossRefPubMedPubMedCentral

10.

Du Y, Tu L, Zhu P et al (2020) Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.202003-0543OC CrossRefPubMedPubMedCentral

11.

Li Z, Wu M, Yao J et al (2020) Kidney dysfunctions of COVID-19 patients: a multi-centered, retrospective, observational study. Social Science Research Network, Rochester, NY

12.

Chen T, Wu D, Chen H et al (2020) Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 368:m1091. https://doi.org/10.1136/bmj.m1091 CrossRefPubMedPubMedCentral

13.

Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323:1061–1069. https://doi.org/10.1001/jama.2020.1585 CrossRefPubMedPubMedCentral

14.

Xu S, Fu L, Fei J, et al (2020) Acute kidney injury at early stage as a negative prognostic indicator of patients with COVID-19: a hospital-based retrospective analysis. https://doi.org/10.1101/2020.03.24.20042408

15.

Yang X, Yu Y, Xu J et al (2020) Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. https://doi.org/10.1016/S2213-2600(20)30079-5 CrossRefPubMedPubMedCentral

16.

Zhou F, Yu T, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395:1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3 CrossRefPubMedPubMedCentral

17.

Xu S, Fu L, Fei J et al (2020) Acute kidney injury at early stage as a negative prognostic indicator of patients with COVID-19: a hospital-based retrospective analysis. medRxiv 2020.03.24.20042408. https://doi.org/10.1101/2020.03.24.20042408

18.

Murugan R, Kellum JA (2011) Acute kidney injury: what’s the prognosis? Nat Rev Nephrol 7:209–217. https://doi.org/10.1038/nrneph.2011.13 CrossRefPubMedPubMedCentral

19.

Chen R, Liang W, Jiang M et al (2020) Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest. https://doi.org/10.1016/j.chest.2020.04.010 CrossRefPubMedPubMedCentral

20.

Anti-2019-nCoV Volunteers, Li Z, Wu M et al (2020) Caution on kidney dysfunctions of 2019-nCoV patients. medRxiv 2020. https://doi.org/10.1101/2020.02.08.20021212

21.

Cao M, Zhang D, Wang Y et al (2020) Clinical features of patients infected with the 2019 novel coronavirus (COVID-19) in Shanghai, China. medRxiv 2020.03.04.20030395. https://doi.org/10.1101/2020.03.04.20030395

22.

Martínez-Rojas MA, Vega-Vega O, Bobadilla NA (2020) Is the kidney a target of SARS-CoV-2? American Journal of Physiology-Renal Physiology ajprenal.00160.2020. https://doi.org/10.1152/ajprenal.00160.2020

23.

Kissling S, Rotman S, Gerber C et al (2020) Collapsing glomerulopathy in a COVID-19 patient. Kidney Int. https://doi.org/10.1016/j.kint.2020.04.006 CrossRefPubMedPubMedCentral

24.

Larsen CP, Bourne TD, Wilson JD et al (2020) Collapsing glomerulopathy in a patient with coronavirus disease 2019 (COVID-19). Kidney Int Rep. https://doi.org/10.1016/j.ekir.2020.04.002 CrossRefPubMedPubMedCentral

25.

Nasr SH, Kopp JB (2020) COVID-19–associated collapsing glomerulopathy: an emerging entity. Kidney Int Rep. https://doi.org/10.1016/j.ekir.2020.04.030 CrossRefPubMedPubMedCentral

26.

Nguyen MT, Maynard SE, Kimmel PL (2009) Misapplications of commonly used kidney equations: renal physiology in practice. Clin J Am Soc Nephrol 4:528–534. https://doi.org/10.2215/CJN.05731108 CrossRefPubMedPubMedCentral

27.

Chen D, Li X, Song Q et al (2020) Hypokalemia and clinical implications in patients with coronavirus disease 2019 (COVID-19). medRxiv 2020. https://doi.org/10.1101/2020.02.27.20028530

28.

Diao B, Wang C, Wang R et al (2020) Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. medRxiv 2020. https://doi.org/10.1101/2020.03.04.20031120

29.

Su H, Yang M, Wan C et al (2020) Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. https://doi.org/10.1016/j.kint.2020.04.003 CrossRefPubMedPubMedCentral

30.

Puelles VG, Lütgehetmann M, Lindenmeyer MT et al (2020) Multiorgan and Renal Tropism of SARS-CoV-2. N Engl J Med. https://doi.org/10.1056/NEJMc2011400 CrossRefPubMedPubMedCentral

31.

Jin M, Tong Q Early Release - Rhabdomyolysis as Potential Late Complication Associated with COVID-19 - Volume 26, Number 7—July 2020 - Emerging Infectious Diseases journal - CDC. https://doi.org/10.3201/eid2607.200445

32.

Risitano AM, Mastellos DC, Huber-Lang M et al (2020) Complement as a target in COVID-19? Nat Rev Immunol. https://doi.org/10.1038/s41577-020-0320-7 CrossRefPubMedPubMedCentral

33.

McCullough JW, Renner B, Thurman JM (2013) The role of the complement system in acute kidney injury. Semin Nephrol. https://doi.org/10.1016/j.semnephrol.2013.08.005 CrossRefPubMedPubMedCentral

34.

Lerolle N, Nochy D, Guérot E et al (2010) Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration. Intensiv Care Med 36:471–478. https://doi.org/10.1007/s00134-009-1723-x CrossRef

35.

Acute kidney injury in the ICU: from injury to recovery: reports from the 5th Paris International Conference. - PubMed - NCBI. https://www.ncbi.nlm.nih.gov/pubmed/28474317. Accessed 23 Apr 2020

36.

Panitchote A, Mehkri O, Hastings A et al (2019) Factors associated with acute kidney injury in acute respiratory distress syndrome. Ann Intensiv Care. https://doi.org/10.1186/s13613-019-0552-5 CrossRef

37.

Hendren NS, Drazner MH, Bozkurt B, Cooper LT (2020) Description and proposed management of the acute COVID-19 cardiovascular syndrome. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.120.047349 CrossRefPubMedPubMedCentral

38.

Darmon M, Schortgen F, Leon R et al (2009) Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation. Intensiv Care Med 35:1031–1038. https://doi.org/10.1007/s00134-008-1372-5 CrossRef

39.

Joannidis M, Forni LG, Klein SJ et al (2020) Lung-kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup. Intensiv Care Med 46:654–672. https://doi.org/10.1007/s00134-019-05869-7 CrossRef

40.

van den Akker JPC, Egal M, Groeneveld ABJ (2013) Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care 17:R98. https://doi.org/10.1186/cc12743 CrossRefPubMedPubMedCentral

41.

Husain-Syed F, Slutsky AS, Ronco C (2016) Lung-kidney cross-talk in the critically Ill patient. Am J Respir Crit Care Med 194:402–414. https://doi.org/10.1164/rccm.201602-0420CP CrossRefPubMed

42.

Annat G, Viale JP, Bui Xuan B et al (1983) Effect of PEEP ventilation on renal function, plasma renin, aldosterone, neurophysins and urinary ADH, and prostaglandins. Anesthesiology 58:136–141. https://doi.org/10.1097/00000542-198302000-00006 CrossRefPubMed

43.

Gattinoni L, Chiumello D, Caironi P et al (2020) COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensiv Care Med. https://doi.org/10.1007/s00134-020-06033-2 CrossRef

44.

Injurious Mechanical Ventilation and End-Organ Epithelial Cell Apoptosis and Organ Dysfunction in an Experimental Model of Acute Respiratory Distress Syndrome | Critical Care Medicine | JAMA | JAMA Network. https://jamanetwork.com/journals/jama/fullarticle/196447. Accessed 23 Apr 2020

45.

Ranieri VM, Giunta F, Suter PM, Slutsky AS (2000) Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome. JAMA 284:43–44. https://doi.org/10.1001/jama.284.1.43 CrossRefPubMed

46.

Hoffmann M, Kleine-Weber H, Schroeder S et al (2020) SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. https://doi.org/10.1016/j.cell.2020.02.052 CrossRefPubMedPubMedCentral

47.

Mizuiri S, Ohashi Y (2015) ACE and ACE2 in kidney disease. World J Nephrol 4:74–82. https://doi.org/10.5527/wjn.v4.i1.74 CrossRefPubMedPubMedCentral

48.

Ransick A, Lindström NO, Liu J et al (2019) Single-cell profiling reveals sex, lineage, and regional diversity in the mouse kidney. Dev Cell 51:399–413.e7. https://doi.org/10.1016/j.devcel.2019.10.005 CrossRefPubMedPubMedCentral

49.

Pan X, Xu D, Zhang H et al (2020) Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensiv Care Med. https://doi.org/10.1007/s00134-020-06026-1 CrossRef

50.

Wang K, Chen W, Zhou Y-S et al (2020) SARS-CoV-2 invades host cells via a novel route: CD147-spike protein. bioRxiv 2020. https://doi.org/10.1101/2020.03.14.988345

51.

Chiu P-F, Su S-L, Tsai C-C et al (2018) Cyclophilin A and CD147 associate with progression of diabetic nephropathy. Free Radic Res 52:1456–1463. https://doi.org/10.1080/10715762.2018.1523545 CrossRefPubMed

52.

Vaduganathan M, Vardeny O, Michel T et al (2020) Renin-Angiotensin-Aldosterone system inhibitors in patients with Covid-19. N Engl J Med 382:1653–1659. https://doi.org/10.1056/NEJMsr2005760 CrossRefPubMed

53.

Deshotels MR, Xia H, Sriramula S et al (2014) Angiotensin II mediates angiotensin converting enzyme type 2 internalization and degradation through an angiotensin II type I receptor-dependent mechanism. Hypertension 64:1368–1375. https://doi.org/10.1161/HYPERTENSIONAHA.114.03743 CrossRefPubMed

54.

Losartan for Patients With COVID-19 Requiring Hospitalization - Full Text View - ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04312009. Accessed 27 Apr 2020

55.

Ferrario CM, Jessup J, Chappell MC et al (2005) Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation 111:2605–2610. https://doi.org/10.1161/CIRCULATIONAHA.104.510461 CrossRefPubMed

56.

Vuille-dit-Bille RN, Camargo SM, Emmenegger L et al (2015) Human intestine luminal ACE2 and amino acid transporter expression increased by ACE-inhibitors. Amino Acids 47:693–705. https://doi.org/10.1007/s00726-014-1889-6 CrossRefPubMed

57.

Zhang P, Zhu L, Cai J et al (2020) Association of inpatient use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19. Circ Res CIRCRESAHA. https://doi.org/10.1161/CIRCRESAHA.120.317134 CrossRef

58.

Yang G, Tan Z, Zhou L et al (2020) Effects Of ARBs And ACEIs On Virus Infection, Inflammatory Status And Clinical Outcomes In COVID-19 Patients With Hypertension: A Single Center Retrospective Study. Hypertension .1:2. Doi: https://doi.org/10.1161/HYPERTENSIONAHA.120.15143

59.

Mancia G, Rea F, Ludergnani M et al (2020) Renin–Angiotensin–Aldosterone system blockers and the risk of Covid-19. N Engl J Med. https://doi.org/10.1056/NEJMoa2006923 CrossRefPubMedPubMedCentral

60.

Reynolds HR, Adhikari S, Pulgarin C et al (2020) Renin–Angiotensin–Aldosterone system inhibitors and risk of Covid-19. N Engl J. https://doi.org/10.1056/NEJMoa2008975 CrossRef

61.

de Abajo FJ, Rodríguez-Martín S, Lerma V et al (2020) Use of renin–angiotensin–aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study. Lancet. 395(10238):1705–1714. https://doi.org/10.1016/S0140-6736(20)31030-8 CrossRefPubMedPubMedCentral

62.

Cunningham PN, Dyanov HM, Park P et al (2002) Acute renal failure in endotoxemia is caused by TNF acting directly on TNF receptor-1 in kidney. J Immunol 168:5817–5823. https://doi.org/10.4049/jimmunol.168.11.5817 CrossRefPubMed

63.

Su H, Lei C-T, Zhang C (2017) Interleukin-6 signaling pathway and its role in kidney disease: an update. Front Immunol 8:405. https://doi.org/10.3389/fimmu.2017.00405 CrossRefPubMedPubMedCentral

64.

Nechemia-Arbely Y, Barkan D, Pizov G et al (2008) IL-6/IL-6R axis plays a critical role in acute kidney injury. JASN 19:1106–1115. https://doi.org/10.1681/ASN.2007070744 CrossRefPubMedPubMedCentral

65.

Desai TR, Leeper NJ, Hynes KL, Gewertz BL (2002) Interleukin-6 causes endothelial barrier dysfunction via the protein kinase C pathway. J Surg Res 104:118–123. https://doi.org/10.1006/jsre.2002.6415 CrossRefPubMed

66.

Sinha P, Delucchi KL, McAuley DF et al (2020) Development and validation of parsimonious algorithms to classify acute respiratory distress syndrome phenotypes: a secondary analysis of randomised controlled trials. Lancet Respir Med 8:247–257. https://doi.org/10.1016/S2213-2600(19)30369-8 CrossRefPubMedPubMedCentral

67.

Opal SM, Laterre P-F, Francois B et al (2013) Effect of eritoran, an antagonist of MD2-TLR4, on mortality in patients with severe sepsis: the access randomized trial. JAMA 309:1154. https://doi.org/10.1001/jama.2013.2194 CrossRefPubMed

68.

Maude SL, Frey N, Shaw PA et al (2014) Chimeric antigen receptor T cells for sustained remissions in leukemia. N Engl J Med 371:1507–1517. https://doi.org/10.1056/NEJMoa1407222 CrossRefPubMedPubMedCentral

69.

Klok FA, Kruip MJHA, van der Meer NJM et al (2020) Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. https://doi.org/10.1016/j.thromres.2020.04.013 CrossRefPubMedPubMedCentral

70.

CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis), Helms J, Tacquard C et al. (2020) High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensiv Care Med. https://doi.org/10.1007/s00134-020-06062-x

71.

Tang N, Li D, Wang X, Sun Z (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 18:844–847. https://doi.org/10.1111/jth.14768 CrossRefPubMedPubMedCentral

72.

Chen C, Lee J, Johnson AE et al (2017) Right ventricular function, peripheral edema, and acute kidney injury in critical illness. Kidney Int Rep 2:1059–1065. https://doi.org/10.1016/j.ekir.2017.05.017 CrossRefPubMedPubMedCentral

73.

Grein J, Ohmagari N, Shin D et al (2020) Compassionate use of remdesivir for patients with severe Covid-19. N Engl J Med. https://doi.org/10.1056/NEJMoa2007016 CrossRefPubMedPubMedCentral

74.

Gaudry S, Hajage D, Schortgen F et al (2016) Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med 375:122–133. https://doi.org/10.1056/NEJMoa1603017 CrossRefPubMed

75.

Ronco C, Reis T, De Rosa S (2020) Coronavirus epidemic and extracorporeal therapies in intensive care: si vis pacem para bellum. Blood Purif. https://doi.org/10.1159/000507039 CrossRefPubMed

Titel: Acute kidney injury in critically ill patients with COVID-19
verfasst von: Paul Gabarre
Guillaume Dumas
Thibault Dupont
Michael Darmon
Elie Azoulay
Lara Zafrani
Publikationsdatum: 12.06.2020
Verlag: Springer Berlin Heidelberg
Schlagwort: COVID-19
Erschienen in: Intensive Care Medicine / Ausgabe 7/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06153-9

Neu im Fachgebiet AINS

Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

31.05.2024 Apoplex Nachrichten

Der optimale Ansatz für die Blutdruckkontrolle bei Patientinnen und Patienten mit akutem Schlaganfall ist noch nicht gefunden. Ob sich eine frühzeitige Therapie der Hypertonie noch während des Transports in die Klinik lohnt, hat jetzt eine Studie aus China untersucht.

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

29.05.2024 Hyponatriämie Nachrichten

Eine ältere Frau trinkt regelmäßig Sennesblättertee gegen ihre Verstopfung. Der scheint plötzlich gut zu wirken. Auf Durchfall und Erbrechen folgt allerdings eine Hyponatriämie. Nach deren Korrektur kommt es plötzlich zu progredienten Kognitions- und Verhaltensstörungen.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Acute kidney injury in critically ill patients with COVID-19

Abstract

Neu im Fachgebiet AINS

Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Update AINS

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2020

IL-6 may be a good biomarker for earlier detection of COVID-19 progression

What’s new in lung ultrasound during the COVID-19 pandemic

Stroke unit care for ischemic stroke in China: results of a nation-based study

Epileptic seizure discharges in patients after open chamber cardiac surgery—a prospective prevalence pilot study using continuous electroencephalography

Managing ICU surge during the COVID-19 crisis: rapid guidelines

Vasopressin versus epinephrine as adjunct vasopressors for septic shock

Neu im Fachgebiet AINS

Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Update AINS