PMID- 33845445
OWN - NLM
STAT- MEDLINE
DCOM- 20211018
LR  - 20220802
IS  - 1557-8615 (Electronic)
IS  - 0883-9441 (Print)
IS  - 0883-9441 (Linking)
VI  - 64
DP  - 2021 Aug
TI  - Cardio-pulmonary-renal interactions in ICU patients. Role of mechanical 
      ventilation, venous congestion and perfusion deficit on worsening of renal 
      function: Insights from the MIMIC-III database.
PG  - 100-107
LID - S0883-9441(21)00059-9 [pii]
LID - 10.1016/j.jcrc.2021.03.013 [doi]
AB  - Background Mechanical ventilation (MV) in ICU patients may impact hemodynamics 
      and renal function. We aimed to describe the interactions of MV settings, 
      hemodynamic parameters and worsening of renal function (WRF). Methods We included 
      adult patients admitted for the first time in the ICU from the MIMIC-III 
      database. Mean arterial blood pressure (mABP), central venous pressure (CVP) and 
      positive end-expiratory pressure (PEEP) were collected and summarized as a 
      time-weighted mean. The main outcome was WRF defined as acute kidney injury (AKI) 
      occurrence or one-KDIGO stage worsening compared to the KDIGO stage the day 
      before. We used a multinomial logistic regression at day 1 (ldmk-1) and day 2 
      (ldmk-2) according to a landmark-approach, with a two-days sliding perspective. 
      Results 27,248/61,051 patients met the inclusion criteria (15,258 male (56.0%); 
      60.1% over 60 y). ICU and hospital mortality were 7.4 and 10.7%, respectively. MV 
      was independently associated with WRF in the ldmrk-1 and -2 models (relative risk 
      ratio [RRR] 8.15 [6.58;10.11] and 7.08 [3.97;12.61] at day-3 and 4, 
      respectively). In MV patients, PEEP was associated with WRF in the ldmrk-1 and -2 
      models (RRR 1.36 [1.16, 1.6] and 1.17 [0.88, 1.56] by 1 cmH(2)O increase at day-3 
      and 4, respectively). Mean perfusion pressure decreased while central venous 
      pressure increased over PEEP categories. In multivariable analysis, mABP, CVP and 
      PEEP were independently associated with WRF. Conclusion In this large cohort of 
      ICU patients, we observed a strong relationship between MV and WRF. PEEP was 
      associated with WRF in MV patients. This association relied at least partly on 
      renal venous congestion.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Geri, Guillaume
AU  - Geri G
AD  - Medical Intensive Care Unit, APHP, Ambroise Pare Hospital, Boulogne-Billancourt, 
      France; Versailles Saint Quentin University, France; INSERM UMR 1018, Team 5 
      Kidney-Heart, Centre de recherche en Epidemiologie et Sante des Populations, 
      Villejuif, France; FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to 
      PerSonalize Interventions for Sepsis), France. Electronic address: 
      guillaume.geri@aphp.fr.
FAU - Ferrer, Loic
AU  - Ferrer L
AD  - Institut Curie, U900, Rene Huguenin Hospital, Saint Cloud, France.
FAU - Tran, Nam
AU  - Tran N
AD  - School of Public Health & Health Systems, University of Waterloo, Canada.
FAU - Celi, Leo A
AU  - Celi LA
AD  - Institute for Medical Engineering and Science, Massachusetts Institute of 
      Technology, Cambridge, MA, United States of America.
FAU - Jamme, Matthieu
AU  - Jamme M
AD  - Versailles Saint Quentin University, France; INSERM UMR 1018, Team 5 
      Kidney-Heart, Centre de recherche en Epidemiologie et Sante des Populations, 
      Villejuif, France; Intensive Care Unit, Poissy Saint Germain Hospital, Poissy, 
      France.
FAU - Lee, Joon
AU  - Lee J
AD  - Data Intelligence for Health Lab, Departments of Community Health Sciences & 
      Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, 
      Canada.
FAU - Vieillard-Baron, Antoine
AU  - Vieillard-Baron A
AD  - Medical Intensive Care Unit, APHP, Ambroise Pare Hospital, Boulogne-Billancourt, 
      France; Versailles Saint Quentin University, France; INSERM UMR 1018, Team 5 
      Kidney-Heart, Centre de recherche en Epidemiologie et Sante des Populations, 
      Villejuif, France; FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to 
      PerSonalize Interventions for Sepsis), France.
LA  - eng
GR  - R01 EB017205/EB/NIBIB NIH HHS/United States
PT  - Journal Article
DEP - 20210329
PL  - United States
TA  - J Crit Care
JT  - Journal of critical care
JID - 8610642
SB  - IM
MH  - Humans
MH  - *Hyperemia
MH  - Intensive Care Units
MH  - Kidney/physiology
MH  - Male
MH  - Perfusion
MH  - *Respiration, Artificial
PMC - PMC9225831
MID - NIHMS1807968
OTO - NOTNLM
OT  - Acute kidney injury
OT  - Mechanical ventilation
OT  - Positive end-expiratory pressure
OT  - Ventilation induced kidney injury
COIS- Competing interest: none
EDAT- 2021/04/13 06:00
MHDA- 2021/10/21 06:00
PMCR- 2022/08/01
CRDT- 2021/04/12 20:28
PHST- 2020/10/06 00:00 [received]
PHST- 2021/02/19 00:00 [revised]
PHST- 2021/03/22 00:00 [accepted]
PHST- 2021/04/13 06:00 [pubmed]
PHST- 2021/10/21 06:00 [medline]
PHST- 2021/04/12 20:28 [entrez]
PHST- 2022/08/01 00:00 [pmc-release]
AID - S0883-9441(21)00059-9 [pii]
AID - 10.1016/j.jcrc.2021.03.013 [doi]
PST - ppublish
SO  - J Crit Care. 2021 Aug;64:100-107. doi: 10.1016/j.jcrc.2021.03.013. Epub 2021 Mar 
      29.