Respiratory parameters and acute kidney injury in acute respiratory distress syndrome: a causal inference study (original) (raw)
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Background Few studies have reported the deleterious association between acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI). We aimed to evaluate the association of AKI and poor outcome in ARDS patients and whether this association is related to fluid overload or not. Patients and methods Sixty-four patients diagnosed with ARDS and had been mechanically ventilated were enrolled. AKI was diagnosed using the Acute Kidney Injury Network criteria. Patients were stratified into two groups according to the degree of renal impairment. All data were statistically analyzed. Results The mean age of the studied patients was 47.23 ±10.12 years; 33 (51.6%) were men. In group 2, the follow-up Lung Injury Severity Score and length of hospital stay were significantly higher compared with group 1: 3.33±0.74 points and 19.11±6.37 days versus 2.84±0.57 points and 12.38 ±4.21 days (P=0.004 and <0.001, respectively). Also, they had higher need to use vasoactive (VA) agents, 21 (55.3%) versus 6 (23.1%) patients, and spent more days on mechanical ventilation, 14.18±4.59 versus 8.51±3.77 (P=0.019 and <0.001, respectively). In-patient mortality was higher in group 2 compared with group 1: 18 (66.7%) versus 6 (23.1%) (P=0.019). In-patient mortality was significantly correlated with the need to use VA agents and higher cumulative fluid balance (R=0.394 and 0.24, P=0.001 and 0.05, respectively). The need to use VA agents was the only independent predictor of mortality (odds ratio=4.18, P=0.022). Conclusion AKI as defined on the basis of the Acute Kidney Injury Network criteria is associated with poor outcome in ARDS patients.
Shock (Augusta, Ga.), 2017
Acute kidney injury (AKI) is a frequent complication in patients under mechanical ventilation (MV). We aimed to assess the risk factors for AKI with particular emphasis on those potentially preventable. Retrospective analysis of a large, multinational database of MV patients with >24 hours of MV and normal renal function at admission. AKI was defined according to creatinine-based KDIGO criteria. Risk factors were analyzed according to the time point at which AKI occurred: early (≤48 hours after ICU admission, AKIE) and late (day 3 to day 7 of ICU stay, AKIL). A conditional logistic regression model was used to identify variables independently associated with AKI. 3206 patients were included. Seven-hundred patients had AKI (22%), the majority of them AKIE (547/704). The risk factor profile was highly dependent upon the timing of AKI onset. In AKIE risk factors were older age; SAPS II score; postoperative and cardiac arrest as the reasons for MV; worse cardiovascular SOFA, pH, seru...
Annals of intensive care, 2018
The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients. The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality. The primary endpoint was all-cause in-hospital mortality. 935 Patients were included. In-hospital mortality was 21%. Compared to patients who died, patients who survived had a lower risk of ARDS according to the 'Lung Injury Prediction Score' and received lower maximum airway pressure (P), driving pressure (ΔP), positive end-expiratory pressure, and FiO levels. Tidal volume size was similar between the groups. Higher P was a potentially modifiable ventilatory variable associated with in-hospital mortality in multivar...