Yokoyama Kazuto, Kaneko Tadashi, Ieki Yohei, Ito Asami, Kawamoto Eiji, Suzuki Kei, Ishikura Ken, Imai Hiroshi
Emergency and Critical Care Center, Mie University Hospital, Tsu, JPN.
Cureus. 2023 Feb 20;15(2):e35233. doi: 10.7759/cureus.35233. eCollection 2023 Feb.
Positive end-expiratory pressure (PEEP), especially continuous high PEEP, is thought to be a risk factor for worsening renal function (WRF) due to impaired venous return and the development of renal interstitial edema. In this study, we investigated whether PEEP is a risk factor for WRF in patients with acute respiratory distress syndrome (ARDS), a representative pathology that requires continuous high PEEP for respiratory management.
We performed retrospective sub-analyses of the Japanese Association for Acute Medicine, a nationwide prospective observational registry of ARDS (FORECAST ARDS registry) prospective multicenter cohort study. WRF was defined on the basis of a worsening renal Sequential Organ Failure Assessment (SOFA) score. We performed univariate and multivariable analyses to identify possible risk factors for WRF, and propensity score analyses to compare the frequency of WRF according to cutoff values for the difference in PEEP between day 1 and day 4.
We analyzed 151 cases. Multivariable analysis showed that the difference in PEEP (odds ratio (OR) 1.123 (95% confidence interval (CI) 1.017-1.240), = 0.022) and male sex (OR 3.287 (95% CI 1.029-10.502), = 0.045) were risk factors for WRF. Propensity score analysis showed trends towards an increased risk for WRF in each cutoff value for the difference in PEEP: -5 cmHO (OR 0.389 (95% CI 0.084-1.799), = 0.229), 0 cmHO (OR 2.222 (95% CI 0.755-6.540), = 0.150), and 5 cmHO (OR 3.277 (95% CI 0.940-11.425), = 0.065).
This study revealed that the difference in PEEP between days 1 and 4 was positively associated with WRF. However, a significant cutoff value for the difference in PEEP was not determined.
呼气末正压（PEEP），尤其是持续高PEEP，被认为是由于静脉回流受损和肾间质水肿发展导致肾功能恶化（WRF）的一个危险因素。在本研究中，我们调查了PEEP是否是急性呼吸窘迫综合征（ARDS）患者WRF的危险因素，ARDS是一种代表性疾病，在呼吸管理中需要持续高PEEP。
我们对日本急性医学协会进行了回顾性亚分析，这是一项全国性的ARDS前瞻性观察登记研究（FORECAST ARDS登记研究），为前瞻性多中心队列研究。WRF根据肾序贯器官衰竭评估（SOFA）评分恶化来定义。我们进行了单变量和多变量分析以确定WRF的可能危险因素，并进行倾向评分分析以根据第1天和第4天PEEP差异的临界值比较WRF的发生频率。
我们分析了151例病例。多变量分析显示，PEEP差异（比值比（OR）1.123（95%置信区间（CI）1.017 - 1.240），P = 0.022）和男性性别（OR 3.287（95%CI 1.029 - 10.502），P = 0.045）是WRF的危险因素。倾向评分分析显示，在PEEP差异的每个临界值处，WRF风险均有增加趋势：-5 cmH₂O（OR 0.389（95%CI 0.084 - 1.799），P = 0.229）、0 cmH₂O（OR 2.222（95%CI 0.755 - 6.540），P = 0.150）和5 cmH₂O（OR 3.277（95%CI 0.940 - 11.425），P = 0.065）。
本研究表明，第1天和第4天之间的PEEP差异与WRF呈正相关。然而，未确定PEEP差异的显著临界值。
