Association Between Acute Kidney Injury During Invasive Mechanical Ventilation and ICU Outcomes and Respiratory System Mechanics.
Association Between Acute Kidney Injury During Invasive Mechanical Ventilation and ICU Outcomes and Respiratory System Mechanics.
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DOI：
10.1097/cce.0000000000000720
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发表时间：
2022-07
影响因子：
--
通讯作者：
Hepokoski ML
中科院分区：
文献类型：
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作者：
Vemuri SV;Rolfsen ML;Sykes AV;Takiar PG;Leonard AJ;Malhotra A;Spragg RG;Macedo E;Hepokoski ML
比较急性肾损伤患者和非急性肾损伤患者在有创机械通气期间ICU预后和呼吸系统力学。回顾性队列研究。2014年1月1日至2016年11月30日，加州大学圣地亚哥分校的icu。根据有创机械通气的需要、有无急性肾损伤（肾病：改善全球结局标准）以及急性肾损伤发生与开始有创机械通气之间的时间关系，对五组患者进行比较。没有。共纳入9704例患者，其中4484例（46%）需要有创机械通气；有创机械通气并发急性肾损伤患者2009例（45%），死亡率为22.4%，而无急性肾损伤的有创机械通气组为5% （p < 0.01）。考虑基线疾病严重程度的校正死亡率风险为1.58 （95% CI, 1.22-2.03; p < 0.001）。急性肾损伤患者在有创机械通气期间的呼吸机总天数和ICU住院时间均显著高于对照组（p < 0.01）。机械通气时急性肾损伤还与平台压升高、呼吸系统顺应性降低和驱动压升高相关（均p < 0.01）。这些差异在净累积体液平衡为负的患者中仍然显著。有创机械通气期间的急性肾损伤与ICU死亡率增加、呼吸机使用天数增加、ICU住院时间延长和呼吸系统力学受损相关。这些结果强调了在急性肾损伤的情况下研究通气策略的必要性，以及危重病人肺和肾之间串扰的机制研究。
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 (p < 0.01). Adjusted hazard of mortality accounting for baseline disease severity was 1.58 (95% CI, 1.22–2.03; p < 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 p < 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 p < 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.