Table 1 [TIMP-2]•[IGFBP7] Protocol* Evaluation of existing clinical protocols: ranked order of actions and avoidances† by risk for AKI

Standard of care

13

No NSAIDs/ACE inhibitors/ARBs

20

Avoid aminoglycosides

6

Remove Foley

11

Keep/insert Foley

19

Renal ultrasound

5

Daily SCr

10

Hourly UO

19

Monitor SVV/Cardiac Index/SVO₂ Q8–12

5

No HD monitoring

9

SCr Q8–12

19

Monitor fluid resuscitation

5

Recheck in 12 h if new insult

7

Avoid contrast

19

Maintenance fluids

5

Daily serum BUN

6

Consider/do renal consult

16

Send urine Na+, urea, creatinine

4

May use NSAIDs/ACE inhibitors

6

Recheck in 8–24 h

14

Check IVC compressibility with ultrasound

4

Diurese if signs of volume overload

6

Minimize/avoid nephrotoxins

13

Consider/use norepinephrine, epinephrine

4

SVO₂ not monitored

5

Consider/use inotropes

11

Vasopressors

4

Mean hourly UO

4

Hold Lasix unless pulmonary edema

11

Dobutamine/Milrinone

4

Consider transfer out of ICU

4

Adjust medication dosing

10

Avoid multiple pressors

4

Consider/do hemodynamic monitoring

9

Sensible fluids

4

Adjust narcotics doses

9

Avoid and resolve hypervolemia (> 10% fluid gain)

4

Consider colloids-only approach

9

Maintain SBP > 90

3

Keep MAP > 65–80

8

Keep MAP ± 10% baseline

3

Serum BUN Q12

7

Consider higher transfusion trigger

3

Monitor SVO₂ if history of abnormal liver function

7

PA catheter

3

IVF expansion

7

Avoid piperacillin-tazobactam

3

May use balanced fluid if CVP < 8 and hypovolemic

7

Low threshold for inotropes if Cardiac Index < 2, ScvO₂ < 70, and/or LA increasing despite adequate MAP and volume expansion

3

Pharmacy consult

7

Goal SVV < 14

2

Urine Na, Cr, Eos ×1

6

Diuretics and fluids to be utilized only after determining fluid status and need with FloTrac, ultrasound, etc.

2

Goal CI > 2.0–2.2

6

Assess fluid responsiveness

2

Avoid vancomycin

6