Lung-protective mechanical ventilation does not protect against acute kidney injury in patients without lung injury at onset of mechanical ventilation

详细信息	查看全文 | 推荐本文 |

• 作者：Bart Cortjens ; MSc^a ; ^{bartcortjens@hotmail.com} ; Annick A.N.M. Royakkers ; MD^b ; ^{aro@hetnet.nl} ; Rogier M. Determann ; MD ; PhD^c ; ^{r.m.determann@amc.uva.nl} ; Jeroen D.E. van Suijlen ; PhD^d ; ^{j.van.suijlen@gelre.nl} ; Stephan S. Kamphuis ; PhD^d ; Jannetje Foppen^d ; ^{j.foppen@gelre.nl} ; Anita de Boer^a ; ^{a.m.deboer@amc.uva.nl} ; Cathrien.W. Wieland ; PhD^a ; ^{c.wieland@amc.uva.nl} ; Peter E. Spronk ; MD ; PhD^e ; ^{p.spronk@gelre.nl} ; Marcus J. Schultz ; MD ; PhD ; FCCP^a ; ^{m.j.schultz@amc.uva.nl} ; Catherine S.C. Bouman ; MD ; PhD^c ; ^{c.s.bouman@amc.uva.nl}
• 关键词：AKI ; acute kidney injury ; ALI ; acute lung injury ; ARDS ; acute respiratory distress syndrome ; CyC ; cystatin C ; GFR ; glomerular filtration rate ; ICU ; intensive care unit ; IQR ; interquartile range ; NGAL ; neutrophil gelatinase&ndash ; associated lipocalin ; RIFL
• 刊名：Journal of Critical Care
• 出版年：2012
• 期刊代码：167_08839441
• 类别：med
• 出版时间：June, 2012
• 卷：27
• 期：3
• 页码：261-267
• 文件大小：338 K

摘要

Introduction

Preclinical and clinical studies suggest that mechanical ventilation contributes to the development of acute kidney injury (AKI), particularly in the setting of lung-injurious ventilator strategies.

Objective

To determine whether ventilator settings in critically ill patients without acute lung injury (ALI) at onset of mechanical ventilation affect the development of AKI.

Design, Setting, and Patients

Secondary analysis of a randomized controlled trial (N = 150), comparing conventional tidal volume (V_T, 10 mL/kg) with low tidal volume (V_T, 6 mL/kg) mechanical ventilation in critically ill patients without ALI at randomization. During the first 5 days of mechanical ventilation, the RIFLE class was determined daily, whereas neutrophil gelatinase-associated lipocalin and cystatin C levels were measured in plasma collected on days 0, 2, and 4.

Results

Eighty-six patients had no AKI at inclusion, and 18 patients (21%) subsequently developed AKI, but without significant difference between ventilation strategies. (Cumulative hazard, 0.26 vs 0.23; P = .88.) The courses of neutrophil gelatinase-associated lipocalin and cystatin C plasma levels did not differ significantly between randomization groups.

Conclusion

In the present study in critically patients without ALI at onset of mechanical ventilation, lower tidal volume ventilation did not reduce the development or worsening of AKI compared with conventional tidal volume ventilation.