Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study

Abstract Background: Lung ultrasound score is a potential method for determining pulmonary edema in acute respiratory distress syndrome. Continuous renal replacement therapy has become the preferred modality to manage fluid overload during acute respiratory distress syndrome. The aim of this study was to evaluate the value of lung ultrasound score on assessing the effects of continuous renal replacement therapy on pulmonary edema and pulmonary function in pediatric acute respiratory distress syndrome. Methods: We conducted a prospective study in children with moderate to severe acute respiratory distress syndrome in a tertiary university pediatric intensive care unit from January 2016 to December 2018. Lung ultrasound score was measured within 2 hours identified acute respiratory distress syndrome as the value of 1st，and the following three days as the 2nd, 3rd, and 4th.Results: A total of 70 patients with acute respiratory distress syndrome were enrolled in this study. Thirty-seven patients received continuous renal replacement therapy (CRRT group) and thirty-three patients treated by conventional therapy (Non-CRRT group). The 1st lung ultrasound score in CRRT group were significantly higher than Non-CRRT group (P < 0.05), but the lung ultrasound score decreased gradually following the continuous renal replacement therapy (P < 0.001). Lung ultrasound score was significantly correlated with PaO2/FiO2, dynamic lung compliance, and oxygen index based on 1st to 4th values (all P<0.001). Lung ultrasound score decreased from 22 (18 - 25) to 15 (13 - 18) and PaO2/FiO2 promoted from 106.00 (96.00 - 121.50) mmHg to 160.00 (142.50 - 173.00) mmHg after continuous renal replacement therapy for four days (both P < 0.001).Conclusions: Lung ultrasound score is closely correlated with PaO2/FiO2, oxygen index and dynamic lung compliance in pediatric acute respiratory distress syndrome. The improvement of pulmonary edema in patient with acute respiratory distress syndrome received continuous renal replacement therapy can be assessed by the lung ultrasound score.Trial registration: CCTR, ChiCTR-ONC-16009698. Registered 1 November 2016, prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=16535&htm=4. This study adheres to CONSORT guidelines.

Download Full-text

Renal Replacement Therapy in Patients with Influenza Pneumonia Related Acute Respiratory Distress Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm10091837 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1837

Author(s):

Ko-Wei Chang ◽

Shaw-Woei Leu ◽

Shih-Wei Lin ◽

Shinn-Jye Liang ◽

Kuang-Yao Yang ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Renal Replacement Therapy ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Replacement Therapy ◽

Distress Syndrome ◽

Pneumonia Severity Index ◽

P Value ◽

Significant Difference ◽

Influenza Pneumonia

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) increases the mortality of acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the outcomes and predictors of RRT in patients with influenza pneumonia-related ARDS. This retrospective cohort study includes patients from eight tertiary referral centers in Taiwan between January and March 2016, and all 282 patients with influenza pneumonia-related ARDS were enrolled. Thirty-four patients suffered from AKI requiring RRT, while 16 patients had underlying end stage renal disease (ESRD). The 30- and 60-day mortality rates were significantly higher in patients with AKI requiring RRT compared with those not requiring RRT (50.0% vs. 19.8%, p value < 0.001; 58.8% vs. 27.2%, p value = 0.001, respectively), but the patients with ESRD had no significant difference in mortality (12.5% vs. 19.8%, p value = 0.744; 31.3% vs. 27.2%, p value = 0.773, respectively). The predictors for AKI requiring RRT included underlying chronic liver disease and C-reactive protein. The mortality predictors for patients with AKI requiring RRT included the pneumonia severity index, tidal volume, and continuous renal replacement therapy. In this study, patients with influenza pneumonia-related ARDS with AKI requiring RRT had significantly higher mortality compared with other patients.

Download Full-text

Early Initiation of Continuous Renal Replacement Therapy Improves Clinical Outcomes in Patients With Acute Respiratory Distress Syndrome

The American Journal of the Medical Sciences ◽

10.1097/maj.0000000000000379 ◽

2015 ◽

Vol 349 (3) ◽

pp. 199-205 ◽

Cited By ~ 26

Author(s):

Fang Han ◽

Renhua Sun ◽

Yin Ni ◽

Xiuping Hu ◽

Xv Chen ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Renal Replacement Therapy ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Clinical Outcomes ◽

Distress Syndrome ◽

Early Initiation

Download Full-text

Prolonged Intermittent Renal Replacement Therapy for Acute Kidney Injury in COVID-19 Patients with Acute Respiratory Distress Syndrome

Blood Purification ◽

10.1159/000510996 ◽

2020 ◽

pp. 1-9

Author(s):

Juan C. Ramirez-Sandoval ◽

Jorge E. Gaytan-Arocha ◽

Pedro Xolalpa-Chávez ◽

Juan M. Mejia-Vilet ◽

Mauricio Arvizu-Hernandez ◽

...

Keyword(s):

Acute Kidney Injury ◽

Acute Respiratory Distress Syndrome ◽

Renal Replacement Therapy ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Replacement Therapy ◽

Distress Syndrome ◽

Kidney Injury ◽

Intradialytic Hypotension ◽

Intermittent Renal Replacement Therapy

Introduction: Patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 frequently develop severe acute kidney injury (AKI). Although continuous renal replacement therapy is the standard of care for critically ill patients, prolonged intermittent renal replacement therapy (PIRRT) may be a feasible option. We aimed to describe the tolerability and security of PIRRT treatments in COVID-19 patients with ARDS who required mechanical ventilation and developed severe AKI. Methods: We prospectively analyzed patients who underwent PIRRT treatments at a COVID-19 reference hospital in Mexico City. Intradialytic hypotension was defined as a systolic blood pressure decrease of ≥20 mm Hg or an increase of 100% in vasopressor dose. Results: We identified 136 AKI cases (60.7%) in 224 patients admitted to the intensive care unit. Among them, 21 (15%) underwent PIRRT (130 sessions) due to stage 3 AKI. The median age of the cohort was 49 (range 36–73) years, 17 (81%) were male, 7 (33%) had diabetes, and the median time between symptoms onset and PIRRT initiation was 12 (interquartile range [IQR] 7–14) days. The median of PIRRT procedures for each patient was 5 (IQR 4–9) sessions. In 108 (83%) PIRRT sessions, the total ultrafiltration goal was achieved. In 84 (65%) PIRRT procedures, there was a median increase in norepinephrine dose of +0.031 mcg/kg/min during PIRRT (IQR 0.00 to +0.07). Intradialytic hypotensive events occurred in 56 (43%) procedures. Fifteen (12%) PIRRT treatments were discontinued due to severe hypotension. Vasopressor treatment at PIRRT session onset (OR 6.2, 95% CI 1.4–28.0, p: 0.02) and a pre-PIRRT lactate ≥3.0 mmol/L (OR 4.63, 95% CI 1.3–12.8, p: 0.003) were independently and significantly associated with the risk of hypotension during PIRRT. During follow-up, 11 patients (52%) recovered from AKI and respiratory failure and 9 (43%) died. Several adaptations to our PIRRT protocol during the COVID-19 outbreak are presented. Conclusions: PIRRT was feasible in the majority of COVID-19 patients with ARDS and severe AKI, despite frequent transitory intradialytic hypotensive episodes. PIRRT may represent an acceptable alternative of renal replacement therapy during the COVID-19 outbreak.

Download Full-text