medigraphic.com
ISSN 2448-8909 (Print)

2019, Number 4

<< Back Next >>

Med Crit 2019; 33 (4)

Haemodynamic variables and outcomes of renal function on intensive care patients

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

Language: Spanish
References: 29
Page: 189-195
PDF size: 192.93 Kb.


ABSTRACT

Introduction: Haemodynamic variables inform us about the progression of acute kidney injury (AKI).
Material and methods: Prospective, observational and longitudinal study of patients admitted to Intensive Care (ICU) from 2017-2018. patients over 18 years were included, with acute kidney injury (AKI 1, 2), and hemodynamic monitoring of mean arterial blood pressure (MAP), diastolic blood pressure (DBP), heart rate (HR) and central venous pressure (CVP). Determined from 24 hours after diagnosis and its evolution was recorded until discharge.
Results: A total of 164 patients were included, progression of AKI presented when MAP ‹ 75.98 mmHg, DBP ‹ 61 mmHg, CVP ‹ 8 cmH2O, FC 90 x’, MAP-CVP 67.64 mmHg, DBP-CVP 53.28 mmHg, HR › 90 beats/minute.
Conclusions: MAP, DBP and CVP have the greatest impact on the risk of AKI progression, especially when the mean perfusion pressure (PPM) is calculated with these two variables.


REFERENCES

  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