Lung-kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup
Lung-kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup
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DOI：
10.1007/s00134-019-05869-7
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发表时间：
2020-04-01
影响因子：
38.9
通讯作者：
Kellum, John A.
中科院分区：
文献类型：
--
作者：
Joannidis, Michael;Forni, Lui G.;Kellum, John A.
背景 危重疾病中的多器官功能障碍很常见，经常涉及肺和肾，通常需要器官支持，例如有创机械通气（IMV）、肾脏替代疗法（RRT）和/或体外膜肺氧合（ECMO）。方法 2018 年 6 月，在奥地利因斯布鲁克，在急性疾病质量倡议 (ADQI) 的支持下，召开了关于危重疾病中肺肾相互作用谱的共识会议。通过对现有证据的审查和严格评估，描述了以下主题的研究现状以及临床和研究建议：流行病学、病理生理学以及减轻急性肾损伤患者和/或急性呼吸衰竭/急性呼吸衰竭患者肾功能不全的策略苦恼综合症。此外，重点关注接受器官支持（RRT、IMV 和/或 ECMO）的患者及其对肺和肾功能的影响。结论 ADQI 第 21 次会议发现，关于肺和肾之间的器官串扰及其与危重患者的相关性存在重大知识差距。肺保护性通气、保守液体管理以及肺部感染的早期识别和治疗是唯一具有更高质量证据的临床建议。制定了研究建议，针对肺肾相互作用，以改善危重疾病的护理过程和结果。
Background Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). Methods A consensus conference on the spectrum of lung-kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. Conclusion The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung-kidney interactions to improve care processes and outcomes in critical illness.