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|RISS 상세보기

다국어 초록 (Multilingual 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.

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참고문헌 (Reference)

1 Gelman S, "Venous function and central venous pressure : a physiologic story" 108 : 735-748, 2008

2 Hu B, "The cytokine storm and COVID-19" 93 : 250-256, 2021

3 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" 22 : 707-710, 1996

4 Xu Z, "Systematic review and subgroup analysis of the incidence of acute kidney injury(AKI)in patients with COVID-19" 22 : 52-, 2021

5 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" 14 : 185-192, 2020

6 Chaibi K, "Severe acute kidney injury in patients with COVID-19 and acute respiratory distress syndrome" 202 : 1299-1301, 2020

7 Hultström M, "Severe acute kidney injury associated with progression of chronic kidney disease after critical COVID-19" 25 : 37-, 2021

8 Hoffmann M, "SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor" 181 : 271-280, 2020

9 Jardin F, "Right ventricular function and positive pressure ventilation in clinical practice : from hemodynamic subsets to respirator settings" 29 : 1426-1434, 2003

10 Migliaccio MG, "Renal involvement in COVID-19 : a review of the literature" 14 : 895-903, 2021