ANZICS CTG, Level 3, 10 Ievers St, Carlton, VIC 3053, Australia.
Intensive Care Med. 2013 Mar;39(3):429-36. doi: 10.1007/s00134-012-2800-0. Epub 2013 Jan 11.
In acute kidney injury patients, metabolic acidosis is common. Its severity, duration, and associated changes in mean arterial pressure (MAP) and vasopressor therapy may be affected by the intensity of continuous renal replacement therapy (CRRT). We aimed to compare key aspects of acidosis and MAP and vasopressor therapy in patients treated with two different CRRT intensities.
We studied a nested cohort of 115 patients from two tertiary intensive care units (ICUs) within a large multicenter randomized controlled trial treated with lower intensity (LI) or higher intensity (HI) CRRT.
Levels of metabolic acidosis at randomization were similar [base excess (BE) of -8 ± 8 vs. -8 ± 7 mEq/l; p = 0.76]. Speed of BE correction did not differ between the two groups. However, the HI group had a greater increase in MAP from baseline to 24 h (7 ± 3 vs. 0 ± 3 mmHg; p < 0.01) and a greater decrease in norepinephrine dose (from 12.5 to 3.5 vs. 5 to 2.5 μg/min; p < 0.05). The correlation (r) coefficients between absolute change in MAP and norepinephrine (NE) dose versus change in BE were 0.05 and -0.37, respectively.
Overall, LI and HI CRRT have similar acid-base effects in patients with acidosis. However, HI was associated with greater improvements in MAP and vasopressor requirements (clinical trial no. NCT00221013).
在急性肾损伤患者中，代谢性酸中毒很常见。其严重程度、持续时间以及平均动脉压（MAP）和血管加压药治疗的相关变化可能受连续肾脏替代治疗（CRRT）强度的影响。我们旨在比较接受两种不同 CRRT 强度治疗的患者酸中毒和 MAP 及血管加压药治疗的关键方面。
我们对来自两个大型多中心随机对照试验的两个三级重症监护病房（ICU）的嵌套队列中的 115 名患者进行了研究，这些患者接受了低强度（LI）或高强度（HI）CRRT 治疗。
随机时的代谢性酸中毒水平相似[基础不足（BE）为-8±8 与-8±7 mEq/L；p=0.76]。两组之间 BE 纠正速度没有差异。然而，HI 组从基线到 24 小时 MAP 增加更大（7±3 与 0±3 mmHg；p<0.01），去甲肾上腺素剂量减少更多（从 12.5 降至 3.5 与 5 降至 2.5 μg/min；p<0.05）。MAP 和去甲肾上腺素（NE）剂量绝对值变化与 BE 变化之间的相关系数分别为 0.05 和-0.37。
总体而言，LI 和 HI CRRT 在酸中毒患者中的酸碱平衡效果相似。然而，HI 与 MAP 和血管加压药需求的更大改善相关（临床试验编号：NCT00221013）。
