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. 2022 Jun 29;4(7):e0720.
doi: 10.1097/CCE.0000000000000720. eCollection 2022 Jul.

Association Between Acute Kidney Injury During Invasive Mechanical Ventilation and ICU Outcomes and Respiratory System Mechanics

Sneha V Vemuri  1   2 , Mark L Rolfsen  2 , Alexandra V Sykes  2 , Puja G Takiar  2 , Austin J Leonard  2 , Atul Malhotra  1   2 , Roger G Spragg  1   2 , Etienne Macedo  2   3 , Mark L Hepokoski  1   2   4
Affiliations

Association Between Acute Kidney Injury During Invasive Mechanical Ventilation and ICU Outcomes and Respiratory System Mechanics

Sneha V Vemuri et al. Crit Care Explor. .

Abstract

Compare ICU outcomes and respiratory system mechanics in patients with and without acute kidney injury during invasive mechanical ventilation.

Designs: Retrospective cohort study.

Settings: ICUs of the University of California, San Diego, from January 1, 2014, to November 30, 2016.

Patients: Five groups of patients were compared based on the need for invasive mechanical ventilation, presence or absence of acute kidney injury per the Kidney Disease: Improving Global Outcomes criteria, and the temporal relationship between the development of acute kidney injury and initiation of invasive mechanical ventilation.

Interventions: None.

Measurements and main results: A total of 9,704 patients were included and 4,484 (46%) required invasive mechanical ventilation; 2,009 patients (45%) had acute kidney injury while being treated with invasive mechanical ventilation, and the mortality rate for these patients was 22.4% compared with 5% in those treated with invasive mechanical ventilation without acute kidney injury (p < 0.01). Adjusted hazard of mortality accounting for baseline disease severity was 1.58 (95% CI, 1.22-2.03; p < 0.001]. Patients with acute kidney injury during invasive mechanical ventilation had a significant increase in total ventilator days and length of ICU stay with the same comparison (both p < 0.01). Acute kidney injury during mechanical ventilation was also associated with significantly higher plateau pressures, lower respiratory system compliance, and higher driving pressures (all p < 0.01). These differences remained significant in patients with net negative cumulative fluid balance.

Conclusions: Acute kidney injury during invasive mechanical ventilation is associated with increased ICU mortality, increased ventilator days, increased length of ICU stay, and impaired respiratory system mechanics. These results emphasize the need for investigations of ventilatory strategies in the setting of acute kidney injury, as well as mechanistic studies of crosstalk between the lung and kidney in the critically ill.

Keywords: acute hypoxemic respiratory failure; acute kidney failure; breathing mechanics; mechanical ventilation; multiple organ dysfunction syndrome; ventilator-induced lung injury.

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Figures

Figure 1.
Figure 1.
Flowchart of the study. aSignificant difference (p < 0.05) when compared with “acute kidney injury (AKI), no invasive mechanical ventilation (IMV).” bSignificant difference (p < 0.05) when compared with “No AKI before/during IMV.” cSignificant difference (p < 0.05) when compared with “AKI before & during IMV.” n = number of cases.
Figure 2.
Figure 2.
30-d survival plot. Plot shows the 30-d hazard of ICU mortality in study groups adjusted for age, gender, nonrenal Sequential Organ Failure Assessment score, ICU location, and the following comorbidities: chronic kidney disease, lung disease, acute coronary dysfunction, congestive heart failure, diabetes mellitus, hypertension, and cerebral vascular accident. Log-rank test, p < 0.001. AKI = acute kidney injury, IMV = invasive mechanical ventilation.
See this image and copyright information in PMC

References

    1. Vincent JL, Marshall JC, Namendys-Silva SA, et al. ; ICON investigators: Assessment of the worldwide burden of critical illness: The intensive care over nations (ICON) audit. Lancet Respir Med 2014; 2:380–386 - PubMed
    1. Terblanche M, Kruger P, di Gangi S, et al. : Risk factors for acute organ failure in intensive care unit patients who receive respiratory support in the absence of non-respiratory organ failure: An international prospective cohort study. Crit Care 2012; 16:R61. - PMC - PubMed
    1. Brower RG, Matthay MA, Morris A, et al. ; Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342:1301–1308 - PubMed
    1. Laffey JG, Engelberts D, Kavanagh BP: Buffering hypercapnic acidosis worsens acute lung injury. Am J Respir Crit Care Med 2000; 161:141–146 - PubMed
    1. Kregenow DA, Rubenfeld GD, Hudson LD, et al. : Hypercapnic acidosis and mortality in acute lung injury. Crit Care Med 2006; 34:1–7 - PubMed