Cardio-pulmonary-renal interactions in ICU patients. Role of mechanical ventilation, venous congestion and perfusion deficit on worsening of renal function: Insights from the MIMIC-III database

医学 机械通风 中心静脉压 急性肾损伤 肾功能 血流动力学 平均动脉压 心脏病学 内科学 呼气末正压 血压 麻醉 心率
作者
Guillaume Géri,L. Ferrer,Nam Tran,Leo Anthony Celi,Matthieu Jamme,Joon Lee,Antoine Vieillard‐Baron
出处
期刊:Journal of Critical Care [Elsevier BV]
卷期号:64: 100-107 被引量:14
标识
DOI:10.1016/j.jcrc.2021.03.013
摘要

Background Mechanical ventilation (MV) in ICU patients may impact hemodynamics and renal function. We aimed to describe the interactions of MV settings, hemodynamic parameters and worsening of renal function (WRF). Methods We included adult patients admitted for the first time in the ICU from the MIMIC-III database. Mean arterial blood pressure (mABP), central venous pressure (CVP) and positive end-expiratory pressure (PEEP) were collected and summarized as a time-weighted mean. The main outcome was WRF defined as acute kidney injury (AKI) occurrence or one-KDIGO stage worsening compared to the KDIGO stage the day before. We used a multinomial logistic regression at day 1 (ldmk-1) and day 2 (ldmk-2) according to a landmark-approach, with a two-days sliding perspective. Results 27,248/61,051 patients met the inclusion criteria (15,258 male (56.0%); 60.1% over 60 y). ICU and hospital mortality were 7.4 and 10.7%, respectively. MV was independently associated with WRF in the ldmrk-1 and -2 models (relative risk ratio [RRR] 8.15 [6.58;10.11] and 7.08 [3.97;12.61] at day-3 and 4, respectively). In MV patients, PEEP was associated with WRF in the ldmrk-1 and -2 models (RRR 1.36 [1.16, 1.6] and 1.17 [0.88, 1.56] by 1 cmH2O increase at day-3 and 4, respectively). Mean perfusion pressure decreased while central venous pressure increased over PEEP categories. In multivariable analysis, mABP, CVP and PEEP were independently associated with WRF. Conclusion In this large cohort of ICU patients, we observed a strong relationship between MV and WRF. PEEP was associated with WRF in MV patients. This association relied at least partly on renal venous congestion.
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