Các tham số siêu âm tim và tình trạng không ổn định huyết động khi bắt đầu liệu pháp thay thế thận liên tục

Springer Science and Business Media LLC - Tập 36 - Trang 173-181 - 2022
Panagiotis Kompotiatis1, Khaled Shawwa1, Jacob C. Jentzer2, Brandon M. Wiley2, Kianoush B. Kashani1,3
1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, USA
2Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, USA

Tóm tắt

Nghiên cứu mối liên quan của các tham số siêu âm tim với tình trạng không ổn định huyết động sau khi bắt đầu liệu pháp thay thế thận liên tục (CKRT) ở một nhóm bệnh nhân trong đơn vị chăm sóc đặc biệt (ICU) cần điều trị CKRT. Nghiên cứu đoàn hệ lịch sử ở những người lớn liên tiếp được nhập viện ICU tại một bệnh viện chuyên khoa từ tháng 12 năm 2006 đến tháng 11 năm 2015, những người đã trải qua CKRT và có siêu âm tim được thực hiện trong vòng bảy ngày trước khi bắt đầu CKRT. Kết quả chính là huyết áp thấp trong vòng một giờ sau khi bắt đầu CKRT. Chúng tôi đã bao gồm 980 bệnh nhân, 804 (82%) có tổn thương thận cấp (AKI) và 176 (18%) bệnh nhân có bệnh thận giai đoạn cuối (ESKD). Tuổi trung bình của bệnh nhân là 63 (± 14) năm, và điểm đánh giá suy tổn cơ quan tuần tự (SOFA) trung bình vào ngày bắt đầu CKRT là 12 (IQR 10–14). Phân tích đa biến cho thấy rằng sự giãn nở thất trái (OR 2.01, 95% CI 1.04–3.86) và giãn nở thất phải (OR 1.5, 95% CI 1.04–2.25) ở mức độ vừa và nặng, điểm số Vasoactive-Inotropic Score (VIS) một giờ trước khi bắt đầu CKRT (OR 1.18 với mỗi 10 đơn vị tăng, 95% CI 1.09–1.28) và sự thay thế dịch bicarbonate cao (OR 2.52, 95% CI 1.01–6.2) có liên quan đến huyết áp thấp sau khi bắt đầu CKRT. Sự giãn nở thất phải và trái là các yếu tố nguy cơ liên quan đến huyết áp thấp sau khi bắt đầu CKRT.

Từ khóa


Tài liệu tham khảo

Cerda J et al (2015) Promoting kidney function recovery in patients with AKI requiring RRT. Clin J Am Soc Nephrol 10(10):1859–1867 Bagshaw SM et al (2005) Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care 9(6):R700–R709 Bagshaw SM et al (2008) Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit Care Med 36(2):610–617 Disease K (2012) Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:1–138 Ronco C, Ricci Z (2008) Renal replacement therapies: physiological review. Intensive Care Med 34(12):2139–2146 Hansrivijit P et al (2020) A meta-analysis of clinical predictors for renal recovery and overall mortality in acute kidney injury requiring continuous renal replacement therapy. J Crit Care 60(1557–8615 (Electronic)):13–22 Bai ZH et al (2020) A nomogram to predict the 28-day mortality of critically Ill patients with acute kidney injury and treated with continuous renal replacement therapy. Am J Med Sci 36(5):607–615 Jentzer JC et al (2020) Early noncardiovascular organ failure and mortality in the cardiac intensive care unit. Clin Cardiol 43(5):516–523 Sasaki S et al (2001) Predictors of mortality in patients treated with continuous hemodiafiltration for acute renal failure in an intensive care setting. ASAIO J 47(1):86–91 Dos Santos TOC et al (2017) Outcomes from a cohort of patients with acute kidney injury subjected to continuous venovenous hemodiafiltration: the role of negative fluid balance. PLoS One 12(4):e0175897 Silversides JA et al (2014) Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: a cohort study. Crit Care 18(6):624 Shawwa K et al (2019) Hypotension within one-hour from starting CRRT is associated with in-hospital mortality. J Crit Care 54:7–13 Reeves PB, Mc Causland FR (2018) Mechanisms, clinical implications, and treatment of intradialytic hypotension. Clin J Am Soc Nephrol 13(8):1297–1303 Augustine JJ et al (2004) A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 44(6):1000–1007 Conger JD (2007) Does hemodialysis delay recovery from acute renal failure? Semin Dial 3(3):146–148 Frederic B, Shaw AD (2014) Clinical trial endpoints in acute kidney injury. Nephron Clin Pract 127(1–4):89–93 Hickson LJ et al (2016) Echocardiography criteria for structural heart disease in patients with end-stage renal disease initiating hemodialysis. J Am Coll Cardiol 67(10):1173–1182 Santosh S et al (2017) Changes in pulmonary artery systolic pressure and right ventricular function in patients with end-stage renal disease on maintenance dialysis. Nephrology 24(1):74–80 Tang M et al (2018) Pulmonary hypertension, mortality, and cardiovascular disease in CKD and ESRD patients: a systematic review and meta-analysis. Am J Kidney Dis 72(1):75–83 Vallabhajosyula S et al (2017) Prognostic impact of isolated right ventricular dysfunction in sepsis and septic shock: an 8-year historical cohort study. Ann Intensive Care 7(1):94 See KC et al (2017) Frequency and prognostic impact of basic critical care echocardiography abnormalities in patients with acute respiratory distress syndrome. Ann Intensive Care 7(1):120 Stamm JA et al (2011) Doppler-defined pulmonary hypertension in medical intensive care unit patients: retrospective investigation of risk factors and impact on mortality. Pulm Circ 1(1):95–102 Keleshian V et al (2019) Short, and long-term mortality among cardiac intensive care unit patients started on continuous renal replacement therapy. J Crit Care 55:64–72 Ferrada P et al (2014) Findings of a randomized controlled trial using limited transthoracic echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay. J Trauma Acute Care Surg 76(1):31 Blum M, Ferrada P (2017) Ultrasound and other innovations for fluid management in the ICU. Surg Clin North Am 97(6):1323–1337 Ferrada P et al (2013) A, B, C, D, echo: limited transthoracic echocardiogram is a useful tool to guide therapy for hypotension in the trauma bay—a pilot study. J Trauma Acute Care Surg 74(1):220–223 Rostoker G et al (2009) Left-ventricular diastolic dysfunction as a risk factor for dialytic hypotension. Cardiology 114(2):142–149 Duman D et al (2008) Dialysis-induced hypotension is associated with impaired aortic elasticity in patients undergoing chronic hemodialysis. Blood Press Monit 13(2):73–78 Alsara A et al (2011) Derivation and validation of automated electronic search strategies to identify pertinent risk factors for postoperative acute lung injury. Mayo Clin Proc 86(5):382–388 Herasevich V et al (2010) Informatics infrastructure for syndrome surveillance, decision support, reporting, and modeling of critical illness. Mayo Clin Proc 85(3):247–254 Singh B et al (2012) Derivation and validation of automated electronic search strategies to extract Charlson comorbidities from electronic medical records. Mayo Clin Proc 87(9):817–824 Jentzer JC et al (2020) Temporal trends and clinical outcomes associated with vasopressor and inotrope use in the cardiac intensive care unit. Shock 53(4):452–459 Kompotiatis P et al (2019) Echocardiographic parameters of patients in the intensive care unit undergoing continuous renal replacement therapy. PLoS One 14(1):e0209994 Nagueh SF et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22(2):107–133 Rudski LG et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713 (quiz 786-8) Zoghbi WA et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16(7):777–802 Baumgartner H et al (2009) Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 22(1):1–23 (quiz 101–2) Felker GM et al (2000) Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 342(15):1077–1084 Martin L et al (2019) The septic heart: current understanding of molecular mechanisms and clinical implications. Chest 155(2):427–437 Shawwa K et al (2021) Change in right ventricular systolic function after continuous renal replacement therapy initiation and renal recovery. J Crit Care 62:82–87 Tehranian S, Shawwa K, Kashani KB (2021) Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy. Clin Kidney J 14(2):564–569 Schaubroeck HA et al (2020) Acute cardiorenal syndrome in acute heart failure: focus on renal replacement therapy. Eur Heart J Acute Cardiovasc Care 9(7):802–811 Kashani K et al (2017) Association between mortality and replacement solution bicarbonate concentration in continuous renal replacement therapy: a propensity-matched cohort study. PLoS One 12(9):e0185064 Pichette C et al (1982) Elevation of the blood lactate concentration by alkali therapy without requiring additional lactic acid accumulation. Crit Care Med 10(5):323–326