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Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France

Gayat Etienne|Mebazaa Alexandre|Basse Pierre|Morisson Louis|Barthélémy Romain|Julian Nathan|Kindermans Manuel|Collet Magalie|Huot Benjamin|Chousterman Benjamin G.
대한중환자의학회 (The Korean Society Of Critical Care Medicine)|2023.05|Acute and Critical Care|제38권 제2호|pp. 172-181|DOI 10.4266/acc.2022.01494

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키워드

COVID-19inflammationacute kidney injurycentral venous pressurepositive end-expiratory pressure

초록

Background The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19). Methods This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count. Results Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002). Conclusions In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

Abstract

Background The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19). Methods This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count. Results Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002). Conclusions In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

참고문헌 (38)

  1. Chan L, "AKI in hospitalized patients with COVID-19", J Am Soc Nephrol, 32, pp.151~160 (2021)
  2. Guan WJ, "Clinical characteristics of coronavirus disease 2019 in China", N Engl J Med, 382, pp.1708~1720 (2020)
  3. Hirsch JS, "Acute kidney injury in patients hospitalized with COVID-19", Kidney Int, 98, pp.209~218 (2020)
  4. Xu Z, "Systematic review and subgroup analysis of the incidence of acute kidney injury(AKI)in patients with COVID-19", BMC Nephrol, 22, pp.52~ (2021)
  5. Chang R, "COVID-19 ICU and mechanical ventilation patient characteristics and outcomes : a systematic review and meta-analysis", PLoS One, 16, pp.e0246318~ (2021)
  6. Costa RL, "Acute kidney injury in patients with Covid-19 in a Brazilian ICU : incidence, predictors and in-hospital mortality", J Bras Nefrol, 43, pp.349~358 (2021)
  7. Yang X, "Acute kidney injury and renal replacement therapy in COVID-19 patients : a systematic review and meta-analysis", Int Immunopharmacol, 90, pp.107159~ (2021)
  8. Hultström M, "Severe acute kidney injury associated with progression of chronic kidney disease after critical COVID-19", Crit Care, 25, pp.37~ (2021)
  9. Hamilton P, "Characteristics and outcomes of hospitalised patients with acute kidney injury and COVID-19", PloS One, 15, pp.e0241544~ (2020)
  10. Doher MP, "Acute kidney injury and renal replacement therapy in critically ill COVID-19 patients : risk factors and outcomes : a single-center experience in Brazil", Blood Purif, 50, pp.520~530 (2021)
  11. Hoffmann M, "SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor", Cell, 181, pp.271~280 (2020)
  12. Zou X, "Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection", Front Med, 14, pp.185~192 (2020)
  13. Migliaccio MG, "Renal involvement in COVID-19 : a review of the literature", Infect Drug Resist, 14, pp.895~903 (2021)
  14. Batlle D, "Acute kidney injury in COVID-19 : emerging evidence of a distinct pathophysiology", J Am Soc Nephrol, 31, pp.1380~1383 (2020)
  15. Legrand M, "Pathophysiology of COVID-19-associated acute kidney injury", Nat Rev Nephrol, 17, pp.751~764 (2021)
  16. Hu B, "The cytokine storm and COVID-19", J Med Virol, 93, pp.250~256 (2021)
  17. Mullins RJ, "Mechanisms of impaired renal function with PEEP", J Surg Res, 37, pp.189~196 (1984)
  18. Priebe HJ, "Mechanisms of renal dysfunction during positive end-expiratory pressure ventilation", J Appl Physiol Respir Environ Exerc Physiol, 50, pp.643~649 (1981)
  19. Legrand M, "Association between systemic hemodynamics and septic acute kidney injury in critically ill patients : a retrospective observational study", Crit Care, 17, pp.R278~ (2013)
  20. Chen KP, "Peripheral edema, central venous pressure, and risk of AKI in critical illness", Clin J Am Soc Nephrol, 11, pp.602~608 (2016)
  21. Geri G, "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", J Crit Care, 64, pp.100~107 (2021)
  22. Le Gall JR, "A new Simplified Acute Physiology Score(SAPS II)based on a European", North American multicenter study, 1993, pp.270, 2957~2963
  23. Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
  24. ARDS Definition Task Force, "Acute respiratory distress syndrome : the Berlin Definition", JAMA, 307, pp.2526~2533 (2012)
  25. Khwaja A, "KDIGO clinical practice guidelines for acute kidney injury", Nephron Clin Pract, 120, pp.c179~84 (2012)
  26. Kork F, "Back-calculating baseline creatinine overestimates prevalence of acute kidney injury with poor sensitivity", Acta Physiol(Oxf), 219, pp.613~624 (2017)
  27. Ottolina D, "Acute kidney injury(AKI)in patients with Covid-19 infection is associated with ventilatory management with elevated positive end-expiratory pressure(PEEP)", J Nephrol, 35, pp.99~111 (2022)
  28. Beurton A, "Limiting positive end-expiratory pressure to protect renal function in SARS-CoV-2 critically ill patients", J Crit Care, 59, pp.191~193 (2020)
  29. Chaibi K, "Severe acute kidney injury in patients with COVID-19 and acute respiratory distress syndrome", Am J Respir Crit Care Med, 202, pp.1299~1301 (2020)
  30. van den Akker JP, "Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill : a systematic review and meta-analysis", Crit Care, 17, pp.R98~ (2013)
  31. Barthélémy R, "Haemodynamic impact of positive end-expiratory pressure in SARS-CoV-2 acute respiratory distress syndrome : oxygenation versus oxygen delivery", Br J Anaesth, 126, pp.e70~2 (2021)
  32. Gelman S, "Venous function and central venous pressure : a physiologic story", Anesthesiology, 108, pp.735~748 (2008)
  33. Vieillard-Baron A, "Experts’ opinion on management of hemodynamics in ARDS patients : focus on the effects of mechanical ventilation", Intensive Care Med, 42, pp.739~749 (2016)
  34. Jardin F, "Right ventricular function and positive pressure ventilation in clinical practice : from hemodynamic subsets to respirator settings", Intensive Care Med, 29, pp.1426~1434 (2003)
  35. Hardenberg JB, "Critical illness and systemic inflammation are key risk factors of severe acute kidney injury in patients with COVID-19", Kidney Int Rep, 6, pp.905~915 (2021)
  36. Lumlertgul N, "Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19 : a cohort study", Ann Intensive Care, 11, pp.123~ (2021)
  37. Cecconi M, "Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine", Intensive Care Med, 40, pp.1795~1815 (2014)
  38. Susen S, "Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring", Crit Care, 24, pp.364~ (2020)

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