• Guillaume Geri, Loic Ferrer, Nam Tran, Leo A Celi, Matthieu Jamme, Joon Lee, and Antoine Vieillard-Baron.
• Medical Intensive Care Unit, APHP, Ambroise Paré Hospital, Boulogne-Billancourt, France; Versailles Saint Quentin University, France; INSERM UMR 1018, Team 5 Kidney-Heart, Centre de recherche en Epidémiologie et Santé des Populations, Villejuif, France; FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), France. Electronic address: guillaume.geri@aphp.fr.
• J Crit Care. 2021 Aug 1; 64: 100-107.

AbstractBackground 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.Copyright © 2021. Published by Elsevier Inc.

13 keywords...

hide…