medigraphic.com
ISSN 2448-8909 (Impreso)

2019, Número 4

<< Anterior Siguiente >>

Med Crit 2019; 33 (4)


Variables hemodinámicas y desenlace de la función renal en pacientes de terapia intensiva

Nájera GEA, Contreras CA, Monares ZE, Aguirre SJS, Camarena AG, Franco GJ

Idioma: Español
Referencias bibliográficas: 29
Paginas: 189-195
Archivo PDF: 192.93 Kb.


RESUMEN

Introducción: Las variables hemodinámicas nos informan sobre la progresión de lesión renal aguda (AKI por sus siglas en inglés).
Material y métodos: Estudio prospectivo, observacional, longitudinal, de pacientes ingresados a la Unidad de Terapia Intensiva del 2017 al 2018. Se incluyeron mayores de 18 años, con lesión renal aguda (AKI 1 o 2), monitoreo hemodinámico de tensión arterial media (TAM), tensión arterial diastólica (PAD), frecuencia cardiaca (FC) y de presión venosa central (PVC). Determinados desde las 24 horas del diagnóstico hasta el egreso.
Resultados: Fueron 164 pacientes, 105 (64%) presentaron progresión de AKI cuando TAM ‹ 75.98 mmHg. PAD ‹ 61, PVC ›8 cm H2O, FC › 90 x’, TAM-PVC ‹ 67.64 mmHg, PAD-PVC ‹ 53.28 mmHg.
Conclusiones: La TAM, PAD y la PVC tienen el mayor impacto en el riesgo de progresión de AKI cuando se calcula la presión de perfusión media con estas variables.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007;35(8):1837-1843; quiz 1852.

  2. Prowle JR, Ishikawa K, May CN, Bellomo R. Renal blood flow during acute renal failure in man. Blood Purif. 2009;28(3):216-225.

  3. Langenberg C, Wan L, Egi M, May CN, Bellomo R. Renal blood flow in experimental septic acute renal failure. Kidney Int. 2006;69(11):1996-2002.

  4. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369(18):1726-1734.

  5. Levy B, Bastien O, Karim B, Cariou A, Chouihed T, Combes A, et al. Experts’ recommendations for the management of adult patients with cardiogenic shock. Ann Intensive Care. 2015;5(1):52.

  6. Perez P, Kimmoun A, Blime V, Levy B. Increasing mean arterial pressure in cardiogenic shock secondary to myocardial infarction: effects on hemodynamics and tissue oxygenation. Shock. 2014;41(4):269-274.

  7. Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370(17):1583-1593.

  8. Li X, Liu M, Bedja D, Thoburn C, Gabrielson K, Racusen L, et al. Acute renal venous obstruction is more detrimental to the kidney than arterial occlusion: implication for murine models of acute kidney injury. Am J Physiol Renal Physiol. 2012;302(5):F519-F525.

  9. Doty JM, Saggi BH, Sugerman HJ, Blocher CR, Pin R, Fakhry I, et al. Effect of increased renal venous pressure on renal function. J Trauma. 1999;47(6):1000-1003.

  10. Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol. 2009;53(7):582-588.

  11. Ostermann M, Hall A, Crichton S. Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients - A retrospective analysis. BMC Nephrol. 2017;18(1):151.

  12. Wong BT, Chan MJ, Glassford NJ, Mårtensson J, Bion V, Chai SY, et al. Mean arterial pressure and mean perfusion pressure deficit in septic acute kidney injury. J Crit Care. 2015;30(5):975-981.

  13. Nisula S, Kaukonen KM, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013;39(3):420-428.

  14. Poukkanen M, Wilkman E, Vaara ST, Pettilä V, Kaukonen KM, Korhonen AM, et al. Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study. Crit Care. 2013;17(6):R295.

  15. Bragadottir G, Redfors B, Ricksten SE. Assessing glomerular filtration rate (GFR) in critically ill patients with acute kidney injury--true GFR versus urinary creatinine clearance and estimating equations. Crit Care. 2013;17(3):R108.

  16. Prowle JR, Kirwan CJ, Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol. 2014;10(1):37-47.

  17. Lagny MG, Jouret F, Koch JN, Blaffart F, Donneau AF, Albert A, et al. Incidence and outcomes of acute kidney injury after cardiac surgery using either criteria of the RIFLE classification. BMC Nephrol. 2015;16:76.

  18. Kellum JA, Chawla LS, Keener C, Singbartl K, Palevsky PM, Pike FL, et al. The effects of alternative resuscitation strategies on acute kidney injury in patients with septic shock. Am J Respir Crit Care Med. 2016;193(3):281-287.

  19. Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, et al. Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med. 2017;43(11):1551-1561.

  20. Kellum JA, Prowle JR. Paradigms of acute kidney injury in the intensive care setting. Nat Rev Nephrol. 2018;14(4):217-230.

  21. Sileanu FE, Murugan R, Lucko N, Clermont G, Kane-Gill SL, Handler SM, et al. AKI in low-risk versus high-risk patients in intensive care. Clin J Am Soc Nephrol. 2015;10(2):187-196.

  22. McCaffrey J, Dhakal AK, Milford DV, Webb NJ, Lennon R. Recent developments in the detection and management of acute kidney injury. Arch Dis Child. 2017;102(1):91-96.

  23. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-1423.

  24. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344-353.

  25. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486-552.

  26. Prowle JR, Bellomo R. Sepsis-associated acute kidney injury: macrohemodynamic and microhemodynamic alterations in the renal circulation. Semin Nephrol. 2015;35(1):64-74.

  27. Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2017;126(1):47-65.

  28. Ronco C, Bellomo R, Kellum JA. Critical care nephrology. In: Garwood S. Section 4, Chapter 28: Acute renal failure pathophysiological principles. Ed. Saunders Elsevier; 2009. pp. 157-164.

  29. Guyton CA. Tratado de fisiología médica. 9a edición. México: Editorial Panamericana; 1997. pp. 1146-1149.




2020     |     www.medigraphic.com