Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation
Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation
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DOI：
10.1007/s00134-008-1372-5
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发表时间：
2009-06-01
影响因子：
38.9
通讯作者：
Brochard, Laurent
中科院分区：
文献类型：
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作者：
Darmon, Michael;Schortgen, Frederique;Brochard, Laurent
短期低氧血症会影响健康个体的利尿和利钠。目前尚无资料显示接受机械通气的危重病人通常可耐受的轻度低氧血症对肾脏的影响。目的：评估机械通气治疗急性肺损伤(ALI)时轻度低氧血症对肾脏的影响。研究对象的动脉血氧饱和度(SaO(2))为96%[94-98]，然后比较88-90%(轻度低氧血症)和98-99%(高氧合)的SaO(2)值。FiO(2)分别设定为0.25[0.23-0.32]和0.7[0.63-0.8]，得到[-90]和99%[98-99]的SaO(2)。血液动力学或呼吸参数不受FiO(2)水平的显著影响。与高氧合水平相比，使用低FiO(2)的轻度低氧血症与利尿增加(中位数[四分位范围]67[四分位范围]67[55-105]对55[45-60]ml/h；P=0.003)和基于多普勒的肾脏阻力指数(RI)增加(0.78[0.66-0.85]对0.72[0.60-0.78]；P=0.003)。计算的2小时内生肌酐清除量也增加(63[46-103]比35[30-85]ml/分钟；P=0.005)，尿肌酐没有变化(P=0.13)。未观察到明显的尿钠变化。在ALI患者中，与短期低FiO(2)有关的轻度低氧血症导致利尿和肾脏RI增加。后一点提示了需要进一步研究的肾内机制。
Short-term hypoxemia affects diuresis and natriuresis in healthy individuals. No data are available on the impact of the mild hypoxemia levels usually tolerated in critically ill patients receiving mechanical ventilation.To assess the renal effects of mild hypoxemia during mechanical ventilation for acute lung injury (ALI).Prospective, physiological study in 12 mechanically ventilated patients with ALI. Patients were studied at baseline with an arterial saturation (SaO(2)) of 96% [94-98] then a comparison was performed between SaO(2) values of 88-90% (mild hypoxemia) and 98-99% (high oxygenation).FiO(2) was set at 0.25 [0.23-0.32] and 0.7 [0.63-0.8], respectively, to obtain SaO(2) of 89 [89-90] and 99% [98-99]. Hemodynamic or respiratory parameters were not significantly affected by FiO(2) levels. Compared with high oxygenation level, mild hypoxemia using low FiO(2) was associated with increase in diuresis (median [interquartile range], 67 [55-105] vs. 55 [45-60] ml/h; P = 0.003) and in doppler-based renal resistive index (RI) (0.78 [0.66-0.85] vs. 0.72 [0.60-0.78]; P = 0.003). The 2-h calculated creatinine clearance also increased (63 [46-103] vs. 35 [30-85] ml/min; P = 0.005) without change in urinary creatinine (P = 0.13). No significant change in natriuresis was observed. Half of the patients were under norepinephrine infusion and the renal response did not differ according to the presence of vasopressors.In patients with ALI, mild hypoxemia related to short-term low FiO(2) induce increases in diuresis and in renal RI. This latter point suggests intra-renal mechanisms that need to be further investigated.