Vemuri Sneha V, Rolfsen Mark L, Sykes Alexandra V, Takiar Puja G, Leonard Austin J, Malhotra Atul, Spragg Roger G, Macedo Etienne, Hepokoski Mark L
Department of Medicine, Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA.
Department of Medicine, School of Medicine, University of California, San Diego.
Crit Care Explor. 2022 Jun 29;4(7):e0720. doi: 10.1097/CCE.0000000000000720. eCollection 2022 Jul.
Compare ICU outcomes and respiratory system mechanics in patients with and without acute kidney injury during invasive mechanical ventilation.
Retrospective cohort study.
ICUs of the University of California, San Diego, from January 1, 2014, to November 30, 2016.
Five groups of patients were compared based on the need for invasive mechanical ventilation, presence or absence of acute kidney injury per the Kidney Disease: Improving Global Outcomes criteria, and the temporal relationship between the development of acute kidney injury and initiation of invasive mechanical ventilation.
None.
A total of 9,704 patients were included and 4,484 (46%) required invasive mechanical ventilation; 2,009 patients (45%) had acute kidney injury while being treated with invasive mechanical ventilation, and the mortality rate for these patients was 22.4% compared with 5% in those treated with invasive mechanical ventilation without acute kidney injury ( < 0.01). Adjusted hazard of mortality accounting for baseline disease severity was 1.58 (95% CI, 1.22-2.03; < 0.001]. Patients with acute kidney injury during invasive mechanical ventilation had a significant increase in total ventilator days and length of ICU stay with the same comparison (both < 0.01). Acute kidney injury during mechanical ventilation was also associated with significantly higher plateau pressures, lower respiratory system compliance, and higher driving pressures (all < 0.01). These differences remained significant in patients with net negative cumulative fluid balance.
Acute kidney injury during invasive mechanical ventilation is associated with increased ICU mortality, increased ventilator days, increased length of ICU stay, and impaired respiratory system mechanics. These results emphasize the need for investigations of ventilatory strategies in the setting of acute kidney injury, as well as mechanistic studies of crosstalk between the lung and kidney in the critically ill.
比较有创机械通气期间合并和未合并急性肾损伤患者的重症监护病房（ICU）结局及呼吸系统力学。
回顾性队列研究。
加利福尼亚大学圣地亚哥分校的ICU，时间为2014年1月1日至2016年11月30日。
根据有创机械通气需求、按照改善全球肾脏病预后组织（KDIGO）标准有无急性肾损伤以及急性肾损伤发生与有创机械通气启动之间的时间关系，对五组患者进行比较。
无。
共纳入9704例患者，其中4484例（46%）需要有创机械通气；2009例患者（45%）在接受有创机械通气治疗时发生急性肾损伤，这些患者的死亡率为22.4%，而接受有创机械通气但未发生急性肾损伤患者的死亡率为5%（P<0.01）。校正基线疾病严重程度后的死亡风险为1.58（95%置信区间，1.22 - 2.03；P<0.001）。有创机械通气期间发生急性肾损伤的患者，总机械通气天数和ICU住院时间显著增加（均P<0.01）。机械通气期间的急性肾损伤还与显著更高的平台压、更低的呼吸系统顺应性和更高的驱动压相关（均P<0.01）。在累积液体平衡净负值的患者中，这些差异仍然显著。
有创机械通气期间的急性肾损伤与ICU死亡率增加、机械通气天数增加、ICU住院时间延长及呼吸系统力学受损有关。这些结果强调了在急性肾损伤背景下对通气策略进行研究的必要性，以及对危重症患者肺肾相互作用机制的研究。
