Marchiset Antoine, Jamme Matthieu
Service de Médecine Intensive Réanimation, Centre Hospitalier de Poissy-Saint Germain en Laye, Poissy, France.
Service de Réanimation, Hôpital Privé de l'Ouest Parisien, Ramsay Générale de Santé, Trappes, France.
Front Nephrol. 2022 Apr 21;2:877529. doi: 10.3389/fneph.2022.877529. eCollection 2022.
Acute kidney injury (AKI) is one of the most frequent causes of organ failure encountered in patients in the intensive care unit (ICU). Because of its predisposition to occur in the most critically ill patients, it is not surprising to observe a high frequency of AKI in patients with acute respiratory distress syndrome (ARDS). However, few studies have been carried out to assess the epidemiology of AKI in subgroups of ARDS patients using recommended KDIGO criteria. Moreover, the mechanisms involved in the physio-pathogenesis of AKI are still poorly understood, in particular the impact of mechanical ventilation on the kidneys. We carried out a review of the literature, focusing on the epidemiology and physiopathology of AKI in patients with ARDS admitted to the ICU. We addressed the importance of clinical management, focusing on mechanical ventilation for improving outcomes, on AKI. Finally, we also propose candidate treatment strategies and management perspectives. Our literature search showed that AKI is particularly common in ICU patients with ARDS. In association with the classic risk factors for AKI, such as comorbidities and iatrogeny, changes in mechanical ventilation parameters, which have been exclusively evaluated for their outcomes on respiratory function and death, must be considered carefully in terms of their impact on the short-term renal prognosis.
急性肾损伤(AKI)是重症监护病房(ICU)患者中最常见的器官衰竭原因之一。由于其易发生于病情最危重的患者,因此在急性呼吸窘迫综合征(ARDS)患者中观察到高频率的AKI并不奇怪。然而,很少有研究使用推荐的KDIGO标准评估ARDS患者亚组中AKI的流行病学。此外,AKI生理发病机制所涉及的机制仍知之甚少,尤其是机械通气对肾脏的影响。我们对文献进行了综述,重点关注入住ICU的ARDS患者中AKI的流行病学和生理病理学。我们阐述了临床管理的重要性,重点是机械通气对改善AKI患者预后的作用。最后,我们还提出了候选治疗策略和管理前景。我们的文献检索表明,AKI在患有ARDS的ICU患者中尤为常见。与AKI的经典危险因素(如合并症和医源性因素)相关,机械通气参数的变化,虽然此前仅评估了其对呼吸功能和死亡的影响,但就其对短期肾脏预后的影响而言,必须仔细考虑。