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Li Z, Zhang H, Xie K, Zhang Y, Zhang Z, Zheng W, Yang T, Zhang L, Yu Y. EARLY INITIATION OF RENAL REPLACEMENT THERAPY IN INTENSIVE CARE UNIT PATIENTS WITH BOTH ACUTE RESPIRATORY DISTRESS SYNDROME AND SEPSIS WITH OR WITHOUT RENAL FAILURE: A RETROSPECTIVE COHORT STUDY BASED ON PROPENSITY SCORE MATCHING. Shock 2023; 59:569-575. [PMID: 36802286 DOI: 10.1097/shk.0000000000002090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
ABSTRACT Background: It is unknown whether early renal replacement therapy (RRT) initiation strategy in intensive care unit (ICU) patients with both acute respiratory distress syndrome (ARDS) and sepsis with or without renal failure is clinically beneficial. Patients and methods: A total of 818 patients with both ARDS and sepsis admitted to the ICU of Tianjin Medical University General Hospital were included in the analysis. Early RRT was defined as initiating the RRT strategy within 24 h of admission. The relationship between early RRT and clinical outcomes, including primary (30-day mortality) and secondary (90-day mortality, serum creatinine, Pa o2 /Fi o2 , duration of invasive mechanical ventilation, cumulative fluid output, and cumulative fluid balance) outcomes, was compared using propensity score matching (PSM). Results: A total of 277 patients (33.9% of the total population) underwent an early RRT initiation strategy before PSM. After PSM, a cohort of 147 patients with early RRT and 147 patients without early RRT with matched baseline characteristics (including serum creatinine at admission) were constructed. Early RRT was not significantly associated with 30- (hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.85-1.85; P = 0.258) or 90-day mortality (HR, 1.30; 95% CI, 0.91-1.87, P = 0.150). At each time point within 72 h after admission, there was no significant difference in serum creatinine, Pa o2 /Fi o2 and duration of mechanical ventilation between the early and the no early RRT groups. Early RRT significantly increased total output at all time points within 72 h of admission and reached a statistically significant negative fluid balance at 48 h. Conclusions: Early RRT initiation strategies had no statistically significant survival benefit in ICU patients with both ARDS and sepsis, with or without renal failure, nor did they significantly improve serum creatinine and oxygenation or shorten the duration of mechanical ventilation. The use and timing of RRT in such patients should be thoroughly investigated.
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Affiliation(s)
- Ziping Li
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Haoyue Zhang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Zhang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhen Zhang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | | | - Tianqi Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Linlin Zhang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
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Oh TK, Song IA. Trends in Mortality, Treatment, and Costs of Management of Acute Respiratory Distress Syndrome in South Korea: Analysis of Data between 2010 and 2019. Yonsei Med J 2022; 63:452-460. [PMID: 35512748 PMCID: PMC9086700 DOI: 10.3349/ymj.2022.63.5.452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Despite recent advances in the understanding and management of acute respiratory distress syndrome (ARDS), trends in treatment, mortality, and healthcare costs following these advancements remain to be identified. In the present study, we aimed to investigate these trends using real-world data from a national cohort database in South Korea. MATERIALS AND METHODS Using the National Health Insurance Service database, we collected and analyzed data for critically ill adult patients with ARDS who were admitted to intensive care units in South Korea between 2010 and 2019. RESULTS The final analysis included 25431 patients with ARDS. The 30-, 90-, and 365-day mortality rates in 2010 were 43.8%, 56.5%, and 68.2%, respectively. These rates had gradually decreased to 36.6%, 50.2%, and 58.8%, respectively, by 2019. Extracorporeal membrane oxygenation support for patients with ARDS started in 2014 at a rate of 5.1% (118/2309), which gradually increased to 8.3% (213/2568) by 2019. The rate of neuromuscular blockade treatment gradually increased from 22.6% (626/2771) in 2010 to 30.9% (793/2568) in 2019. The renal replacement therapy rate gradually increased from 5.7% (157/2771) in 2010 to 12.0% (307/2568) in 2019. The mean total cost of hospitalization increased from 5986.7 USD in 2010 to 12336.4 USD in 2019. CONCLUSION Real-world data for 2010-2019 indicate that patients with ARDS in South Korea have experienced changes in mortality, treatment, and healthcare costs. Despite the increased financial burden, mortality among patients with ARDS has decreased due to advances in disease management.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Marchiset A, Jamme M. When the Renal (Function) Begins to Fall: A Mini-Review of Acute Kidney Injury Related to Acute Respiratory Distress Syndrome in Critically Ill Patients. FRONTIERS IN NEPHROLOGY 2022; 2:877529. [PMID: 37675005 PMCID: PMC10479595 DOI: 10.3389/fneph.2022.877529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 09/08/2023]
Abstract
Acute kidney injury (AKI) is one of the most frequent causes of organ failure encountered in patients in the intensive care unit (ICU). Because of its predisposition to occur in the most critically ill patients, it is not surprising to observe a high frequency of AKI in patients with acute respiratory distress syndrome (ARDS). However, few studies have been carried out to assess the epidemiology of AKI in subgroups of ARDS patients using recommended KDIGO criteria. Moreover, the mechanisms involved in the physio-pathogenesis of AKI are still poorly understood, in particular the impact of mechanical ventilation on the kidneys. We carried out a review of the literature, focusing on the epidemiology and physiopathology of AKI in patients with ARDS admitted to the ICU. We addressed the importance of clinical management, focusing on mechanical ventilation for improving outcomes, on AKI. Finally, we also propose candidate treatment strategies and management perspectives. Our literature search showed that AKI is particularly common in ICU patients with ARDS. In association with the classic risk factors for AKI, such as comorbidities and iatrogeny, changes in mechanical ventilation parameters, which have been exclusively evaluated for their outcomes on respiratory function and death, must be considered carefully in terms of their impact on the short-term renal prognosis.
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Affiliation(s)
- Antoine Marchiset
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Poissy-Saint Germain en Laye, Poissy, France
| | - Matthieu Jamme
- Service de Réanimation, Hôpital Privé de l’Ouest Parisien, Ramsay Générale de Santé, Trappes, France
- INSERM UMR 1018, Equipe Epidémiologie Clinique, CESP, Villejuif, France
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Abstract
Acute kidney injury (AKI) complicates approximately a third of all acute respiratory distress syndrome (ARDS) cases, and the combination of the two drastically worsens prognosis. Recent advances in ARDS supportive care have led to improved outcomes; however, much less is known on how to prevent and support patients with AKI and ARDS together. Understanding the dynamic relationship between the kidneys and lungs is crucial for the practicing intensivist to prevent injury. This article summarizes key concepts for the critical care physician managing a patient with ARDS complicated by AKI. Also provided is a discussion of AKI in the COVID-19 era.
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Affiliation(s)
- Bryan D Park
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Internal Medicine, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Box C272, Aurora, CO 80045, USA
| | - Sarah Faubel
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Box C281, Aurora, CO 80045, USA.
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Abstract
Emerging evidence from observational studies suggests that both slower and faster net ultrafiltration rates during kidney replacement therapy are associated with increased mortality in critically ill patients with acute kidney injury and fluid overload. Faster rates are associated with ischemic organ injury. The net ultrafiltration rate should be prescribed based on patient body weight in milliliters per kilogram per hour, with close monitoring of patient hemodynamics and fluid balance. Randomized trials are required to examine whether moderate net ultrafiltration rates compared with slower and faster rates are associated with reduced risk of hemodynamic instability, organ injury, and improved outcomes.
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Affiliation(s)
- Vikram Balakumar
- Department of Critical Care Medicine, Mercy Hospitals, Springfield, MO, USA; Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. https://twitter.com/vikrambalakumar
| | - Raghavan Murugan
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, University of Pittsburgh, 3347 Forbes Avenue, Suite 220, Room 206, Pittsburgh, PA 15261, USA.
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Wang F, Wang C, Shi J, Shan Y, Miao H, Sun T, Zhou Y, Zhang Y. Lung ultrasound score assessing the pulmonary edema in pediatric acute respiratory distress syndrome received continuous hemofiltration therapy: a prospective observational study. BMC Pulm Med 2021; 21:40. [PMID: 33494739 PMCID: PMC7830818 DOI: 10.1186/s12890-021-01394-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Lung ultrasound score is a potential method for determining pulmonary edema in acute respiratory distress syndrome (ARDS). Continuous renal replacement therapy (CRRT) has become the preferred modality to manage fluid overload during ARDS. The aim of this study was to evaluate the value of lung ultrasound (LUS) score on assessing the effects of CRRT on pulmonary edema and pulmonary function in pediatric ARDS. Methods We conducted a prospective cohort study in 70 children with moderate to severe ARDS in a tertiary university pediatric intensive care unit from January 2016 to December 2019. 37 patients received CRRT (CRRT group) and 33 patients treated by conventional therapy (Non-CRRT group). LUS score was measured within 2 h identified ARDS as the value of 1st, and the following three days as the 2nd, 3rd, and 4th. We used Spearman correlation analysis to develop the relationship between LUS score and parameters related to respiratory dynamics, clinical outcomes as well as daily fluid balance during the first four days after ARDS diagnosed. Results The 1st LUS score in CRRT group were significantly higher than Non-CRRT group (P < 0.001), but the LUS score decreased gradually following CRRT (P < 0.001). LUS score was significantly correlated with Cdyn (dynamic lung compliance) (1st: r = − 0.757, 2nd: r = − 0.906, 3rd: r = − 0.885, 4th: r = − 0.834), OI (oxygenation index) (1st: r = 0.678, 2nd: r = 0.689, 3rd: r = 0.486, 4th: r = 0.324) based on 1st to 4th values (all P < 0.05). Only values of the 3rd and 4th LUS score after ARDS diagnosed were correlated with duration of mechanical ventilation [1st: r = 0.167, P = 0.325; 2nd: r = 0.299, P = 0.072; 3rd: r = 0.579, P < 0.001; 4th: r = 0.483, P = 0.002]. LUS score decreased from 22 (18–25) to 15 (13–18) and OI decreased from 15.92 (14.07–17.73) to 9.49 (8.70–10.58) after CRRT for four days (both P < 0.001). Conclusions LUS score is significantly correlated with lung function parameters in pediatric ARDS. The improvement of pulmonary edema in patient with ARDS received CRRT can be assessed by the LUS score. Trial registration CCTR, ChiCTR-ONC-16009698. Registered 1 November 2016, prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=16535&htm=4. This study adheres to CONSORT guidelines.
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Affiliation(s)
- Fei Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Jingyi Shi
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Yijun Shan
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Huijie Miao
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Ting Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Yiping Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China. .,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China.
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Raina R, Joshi H, Chakraborty R. Changing the terminology from kidney replacement therapy to kidney support therapy. Ther Apher Dial 2020; 25:437-457. [PMID: 32945598 DOI: 10.1111/1744-9987.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/16/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Abstract
Kidney replacement therapy (KRT) is a common supportive treatment for renal dysfunction, especially acute kidney injury. However, critically ill or immunosuppressed patients with renal dysfunction often have dysfunction in other organs as well. To improve patient outcomes, clinicians began to initiate kidney replacement therapy in situations where nonrenal conditions may lead to acute kidney injury, such as septic shock, hematopoietic stem cell transplantation, veno-occlusive renal disease, cardiopulmonary bypass, chemotherapy, tumor lysis syndrome, hyperammonemia, and various others. In this review, we discuss the use of various modes of kidney replacement therapy in treating renal and nonrenal complications to illustrate why kidney support therapy is a more appropriate terminology than kidney replacement therapy.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, Ohio, USA.,Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Hirva Joshi
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Ronith Chakraborty
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, Ohio, USA
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