基于灌注的连续肾脏替代治疗中再复灌：一项前后对照的初步研究（早期干燥队列）。

Perfusion-based deresuscitation during continuous renal replacement therapy: A before-after pilot study (The early dry Cohort).

机构信息

Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 59, Boulevard Pinel, 69677 Bron Cedex, France; Faculté de médecine Lyon Est, Université Claude Bernard Lyon 1, 8, Avenue Rockefeller, 69373 Lyon, Cedex 08, France.

Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 59, Boulevard Pinel, 69677 Bron Cedex, France.

出版信息

J Crit Care. 2022 Dec;72:154169. doi: 10.1016/j.jcrc.2022.154169. Epub 2022 Oct 3.

DOI:10.1016/j.jcrc.2022.154169

PMID:36201978

Abstract

BACKGROUND

Active fluid removal has been suggested to improve prognosis following the resolution of acute circulatory failure. We have implemented a routine care protocol to guide fluid removal during continuous renal replacement therapy (CRRT). We designed a before-after pilot study to evaluate the impact of this deresuscitation strategy on the fluid balance.

METHODS

Consecutive ICU patients suffering from fluid overload and undergoing CRRT for acute kidney injury underwent a perfusion-based deresuscitation protocol combining a restrictive intake, net ultrafiltration (UFnet) of 2 mL/kg/h, and monitoring of perfusion (early dry group, N = 42) and were compared to a historical group managed according to usual practices (control group, N = 45). The primary outcome was the cumulative fluid balance at day 5 or at discharge.

RESULTS

Adjusted cumulative fluid balance was significantly lower in the early dry group (median [IQR]: -7784 [-11,833 to -2933] mL) compared to the control group (-3492 [-9935 to -1736] mL; p = 0.04). The difference was mainly driven by a greater daily UFnet (31 [22-46] mL/kg/day vs. 24 [15-32] mL/kg/day; p = 0.01). There was no significant difference between both groups regarding hemodynamic tolerance.

CONCLUSION

Our perfusion-based deresuscitation protocol achieved a greater negative cumulative fluid balance compared to standard practices and was hemodynamically well tolerated.

摘要

背景

在急性循环衰竭得到解决后，主动去除液体被认为可以改善预后。我们已经实施了一项常规护理方案，以指导连续性肾脏替代治疗（CRRT）期间的液体去除。我们设计了一项前后试点研究，以评估这种复苏策略对液体平衡的影响。

方法

连续因液体超负荷且正在接受急性肾损伤 CRRT 的 ICU 患者接受了基于灌注的复苏策略，该策略结合了限制摄入、净超滤（UFnet）2 毫升/公斤/小时和灌注监测（早期干燥组，N=42），并与根据常规实践进行管理的历史组（对照组，N=45）进行比较。主要结局是第 5 天或出院时的累积液体平衡。

结果

与对照组相比（中位数[IQR]：-3492[-9935 至-1736]毫升），早期干燥组的累积液体平衡明显更低（中位数[IQR]：-7784[-11,833 至-2933]毫升；p=0.04）。差异主要归因于每日 UFnet 更大（31[22-46]毫升/公斤/天比 24[15-32]毫升/公斤/天；p=0.01）。两组之间在血流动力学耐受性方面没有显著差异。