การพยาบาลเพื่อป้องกันการเกิดภาวะไตบาดเจ็บเฉียบพลัน ในผู้ป่วยช็อกจากการติดเชื้อตามหลักฐานเชิงประจักษ์

Chetthaporn Chanlertlit; Juree Sansuk

Authors

Chetthaporn Chanlertlit Boromarajonani College of Nursing, Khon Kaen, Faculty of Nursing, Praboromarajchanok Institute
Juree Sansuk Boromarajonani College of Nursing, Khon Kaen, Faculty of Nursing, Praboromarajchanok Institute

Keywords:

evidence-based nursing, acute kidney injury, septic shock

Abstract

Introduction: Acute Kidney Injury (AKI) is a common and serious complication in patients with septic shock, particularly in intensive care units, and is associated with high mortality and decreased quality of life. Effective nursing strategies to prevent AKI must be grounded in evidence-based practice (EBP)
to improve patient outcomes and minimize complications.

Objectives: This study aims to collect, analyze, and synthesize current evidence on nursing interventions that help prevent AKI in patients with septic shock. The focus is on reducing clinical risks, enabling early identification, and implementing practical, evidence-based nursing care.

Key Issues: Key nursing practices identified include early risk assessment using standardized tools such as the National Early Warning Score (NEWS) and the Quick Sequential Organ Failure Assessment (qSOFA); diagnosis of AKI based on the KDIGO 2012 criteria; appropriate management of fluid balance and blood pressure; avoidance or adjustment of nephrotoxic medications and continuous renal function monitoring. Additionally, patient and family education is essential, emphasizing adequate hydration and the avoidance of AKI risk factors.

Conclusions: Evidence-based nursing care is essential for preventing AKI in patients with septic shock. Early risk identification, appropriate fluid therapy, cautious use of nephrotoxic agents, and continuous renal monitoring are critical components. Integrating these interventions into clinical practice guidelines can improve outcomes and reduce complications in critically ill patients.

Implications: The findings highlight the need to develop and implement nursing protocols based on high-quality evidence, support continuous staff education, utilize automated monitoring systems for AKI, and foster interprofessional collaboration. These measures collectively contribute to enhanced patient safety and improved quality of care in septic shock management.

Downloads

Download data is not yet available.

References

Ostermann M, Lumlertgul N, Jeong R, See E, Joannidis M, Jame M. Acute kidney injury. The Lancet 2025;405(10474):241-56.

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine 2021;47(11):1181-247.

Adiyeke E, Ren Y, Fogel S, Rashidi P, Segal M, Shenkman EA, et al. Epidemiology, trajectories and outcomes of acute kidney injury among hospitalized patients: a large retrospective multicenter cohort study. Journal of Nephrology [Internet]. 2025 [cited 2024 April 12]. Available from: https://doi.org/10.1007/s40620-025-02234-4

Nakwan S. Incidence, risk factors, and consequences of acute kidney failure in patients in the intensive care unit, Ratchaburi Hospital. Region 4-5 Medical Journal 2020;39(4);656-67. (in Thai)

Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ [Internet]. 2019 [cited 2024 April 12];364:k4891. Available from: https://www.bmj.com/content/364/bmj.k4891.long

Ibarz M, Haas LEM, Ceccato A, Artigas A. The critically ill older patient with sepsis: a narrative review. Annals of Intensive Care [Internet]. 2024 [cited 2024 April 12];14(1):6. Available from: https://doi.org/10.1186/s13613-023-01233-7

Division Of Non-Communicable Diseases, Ministry of Public Health. Number and incidence rate, 2016–2020. Nonthaburi: Division of Non-Communicable Diseases, Ministry of Public Health; 2020. (in Thai)

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801-10.

Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical practice 2012;120(4):c179-84.

Kellum JA, Romagnani P, Ashuntantang G, Ronco C, Zarbock A, Anders HJ, et al. Acute kidney injury. Nature Reviews Disease Primers [Internet]. 2021 [cited 2024 April 12];7(1):52. Available from: https://www.nature.com/articles/s41572-021-00284-z

Raimundo M, Crichton S, Martin JR, Syed Y, Varrier M, Wyncoll D, et al. Increased fluid administration after early acute kidney injury is associated with less renal recovery. Shock. 2015;44(5):431-7.

Goyal A, Daneshpajouhnejad P, Hashmi MF, Bashir K. Acute kidney injury [Internet]. 2025 [cited 2024 April 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441896/

Hinkaew B. Nursing care for patients with acute kidney injury: a case study. Thai Red Cross Nursing Journal 2016;9(9):46–62.(in Thai)

Ronco C, Bellomo R, Kellum, JA. Acute kidney injury. The Lancet 2019;19(394):1949-64.

Dos Santos WM, Secoli SR, Püschel VAA. The Joanna Briggs Institute approach for systematic reviews. Revista Latino-Americana De Enfermagem [Internet]. 2018 [cited 2024 April 12];26:e3074. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6248737/pdf/0104-1169-rlae-26-e3074.pdf

Suepkinra A, Methakanjanasak M. Effects of nursing practice guidelines for the prevention of acute kidney injury in critically ill trauma patients at Khon Kaen Hospital. Journal of Nursing and Health Care 19;37(2);208-17. (in Thai)

Waeyaei A, Chanruangvanich W, Thosingha O, Keorochana K. Factors predicting the severity of acute kidney injury in trauma patients within 48 hours. Journal of Thailand Nursing And Midwifery Council 2019;34(1);122-40. (in Thai)

National Clinical Guideline Centre. Acute kidney injury: prevention, detection and management up to the point of renal replacement therapy. London: Royal College of Physicians (UK); 2013.

Faisal M, Scally A, Elgaali MA, Richardson D, Beatson K, Mohammed MA.The national early warning score and its subcomponents recorded within ±24 h of emergency medical admission are poor predictors of hospital-acquired acute kidney injury. Clinical Medicine (London, England) 2018;18(1):47-53.

Ronco C, Kellum JA, Bellomo R, Mehta RL. Acute dialysis quality initiative (ADQI). Contributions To Nephrology 2013;182:1-4.

Chawla LS, Bellomo, R., Bihorac, A., Goldstein, S. L., Siew, ED, Bagshaw SM, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nature Reviews Nephrology 2017;13(4):241-57.

Zhou J, Yang, L, Zhang, K, Liu, Y, Fu, P. Risk factors for the prognosis of acute kidney injury under the acute kidney injury network definition: a retrospective, multicenter study in critically ill patients. Nephrology. 2012 May;17(4):330-7.

Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, et al. The Japanese clinical practice guideline for acute kidney injury 2016. Clinical and Experimental Nephrology 2018;22(5):985-1045.

Vijayan A, Faubel, S., Askenazi, D. J., Cerda, J., Fissell, WH, Heung M, et al. Clinical use of the urine biomarker for acute kidney injury risk assessment. American Journal of Kidney Diseases. 2016;68(1):19-28.

Castera MR, Borhade MB. Fluid management [Internet]. 2025 [cited 2024 April 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532305/

Kidney Disease Improving Global Outcomes. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International 2024;105(4s):S117-314.

Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, et al. Performance evaluation of a multinational data platform for critical care in Asia. Wellcome Open Research 2021;6:251.

Fortrie G, de Geus HRH, Betjes MGH. The aftermath of acute kidney injury: a narrative review of long-term mortality and renal function. Critical Care 2019;23(1):24.

Yu Y, Li C, Zhu S, Jin L, Hu Y, Ling X, Miao C, et al. Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review. European Journal of Medical Research 2023;28(1):45.

Seitz KP, Caldwell ES, Hough CL. Fluid management in ARDS: an evaluation of current practice and the association between early diuretic use and hospital mortality. Journal of Intensive Care 2020;8(1):78.

Husain-Syed F, Takeuchi T, Neyra JA, Ramírez-Guerrero G, Rosner MH, et al. Acute kidney injury in neurocritical care. Critical Care. 2023;27(1):341.

Levy B, Fritz C, Tahon E, Jacquot A, Auchet T, Kimmoun A. Vasoplegia treatments: the past, the present, and the future. Critical Care 2018;22(1):52.

Ueyama H, Kiyonaka S. Predicting the need for fluid therapy-does fluid responsiveness work?. Journal of Intensive Care 2017;5(1):34.

Pais T, Jorge S, Lopes JA. Acute kidney injury in sepsis. International Journal of Molecular Sciences 2024;25(11):5924.

Machado MN, Nakazone MA, Maia LN. Acute kidney injury based on KDIGO (Kidney disease improving global outcomes) criteria in patients with elevated baseline serum creatinine undergoing cardiac surgery. Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular 2014;29(3):299-307.

Libório AB, Leite TT, Neves FM, Teles F, Bezerra CT. AKI complications in critically ill patients: association with mortality rates and RRT. Clinical Journal of The American Society of Nephrology 2015;10(1):21-8.

Monnet X, Teboul J-L. Passive leg raising: five rules, not a drop of fluid!. Critical Care [Internet]. 2015;19(1):18.

Astapenko D, Navratil P, Pouska J, Cerny V. Clinical physiology aspects of chloremia in fluid therapy: a systematic review. Perioperative Medicine 2020;9(1):40.

Centers for Disease Control and Prevention. CDC's core infection prevention and control practices for safe healthcare delivery in all settings [Internet]. 2024 [cited 2024 April 12]. Available from: https://www.cdc.gov/infection-control/hcp/core-practices/index.html