Unidade Central de Terapia Intensiva, Complexo Hospitalar Santa Casa de Porto Alegre - Porto Alegre (RS), Brasil.
Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.
Rev Bras Ter Intensiva. 2020 Oct-Dec;32(4):564-570. doi: 10.5935/0103-507X.20200094.
To evaluate renal responsiveness in oliguric critically ill patients after a fluid challenge.
We conducted a prospective observational study in one university intensive care unit. Patients with urine output < 0.5mL/kg/h for 3 hours with a mean arterial pressure > 60mmHg received a fluid challenge. We examined renal fluid responsiveness (defined as urine output > 0.5mL/kg/h for 3 hours) after fluid challenge.
Forty-two patients (age 67 ± 13 years; APACHE II score 16 ± 6) were evaluated. Patient characteristics were similar between renal responders and renal nonresponders. Thirteen patients (31%) were renal responders. Hemodynamic or perfusion parameters were not different between those who did and those who did not increase urine output before the fluid challenge. The areas under the receiver operating characteristic curves were calculated for mean arterial pressure, heart rate, creatinine, urea, creatinine clearance, urea/creatinine ratio and lactate before the fluid challenge. None of these parameters were sensitive or specific enough to predict reversal of oliguria.
After achieving hemodynamic stability, oliguric patients did not increase urine output after a fluid challenge. Systemic hemodynamic, perfusion or renal parameters were weak predictors of urine responsiveness. Our results suggest that volume replacement to correct oliguria in patients without obvious hypovolemia should be done with caution.
评估液体冲击后少尿危重症患者的肾脏反应性。
我们在一家大学重症监护病房进行了一项前瞻性观察研究。尿量<0.5mL/kg/h 持续 3 小时且平均动脉压>60mmHg 的患者接受液体冲击。我们在液体冲击后检查肾脏液体反应性（定义为尿量>0.5mL/kg/h 持续 3 小时）。
42 名患者（年龄 67±13 岁；APACHE II 评分 16±6）进行了评估。肾脏反应者和肾脏无反应者的患者特征相似。13 名患者（31%）为肾脏反应者。在进行液体冲击之前，那些尿量增加的患者和那些没有增加尿量的患者之间的血流动力学或灌注参数没有差异。在液体冲击之前计算平均动脉压、心率、肌酐、尿素、肌酐清除率、尿素/肌酐比值和乳酸的受试者工作特征曲线下面积。这些参数均不能敏感或特异性地预测少尿的逆转。
在达到血流动力学稳定后，少尿患者在液体冲击后没有增加尿量。全身血流动力学、灌注或肾脏参数是尿反应性的弱预测指标。我们的结果表明，对于没有明显低血容量的患者，应谨慎进行容量替代以纠正少尿。
