tetano
Editor, Senior Moderator
Acute Crit Care
. 2023 May;38(2):172-181.
doi: 10.4266/acc.2022.01494. Epub 2023 May 25. 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
Pierre Basse[SUP] 1 [/SUP], Louis Morisson[SUP] 2 [/SUP], Romain Barthélémy[SUP] 1 [/SUP], Nathan Julian[SUP] 1 [/SUP], Manuel Kindermans[SUP] 1 [/SUP], Magalie Collet[SUP] 1 [/SUP], Benjamin Huot[SUP] 1 [/SUP], Etienne Gayat[SUP] 1 3 [/SUP], Alexandre Mebazaa[SUP] 1 3 [/SUP], Benjamin G Chousterman[SUP] 1 3 [/SUP]
Affiliations
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.
Keywords: COVID-19; acute kidney injury; central venous pressure; inflammation; positive end-expiratory pressure.
. 2023 May;38(2):172-181.
doi: 10.4266/acc.2022.01494. Epub 2023 May 25. 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
Pierre Basse[SUP] 1 [/SUP], Louis Morisson[SUP] 2 [/SUP], Romain Barthélémy[SUP] 1 [/SUP], Nathan Julian[SUP] 1 [/SUP], Manuel Kindermans[SUP] 1 [/SUP], Magalie Collet[SUP] 1 [/SUP], Benjamin Huot[SUP] 1 [/SUP], Etienne Gayat[SUP] 1 3 [/SUP], Alexandre Mebazaa[SUP] 1 3 [/SUP], Benjamin G Chousterman[SUP] 1 3 [/SUP]
Affiliations
- PMID: 37313663
- DOI: 10.4266/acc.2022.01494
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.
Keywords: COVID-19; acute kidney injury; central venous pressure; inflammation; positive end-expiratory pressure.