Acute Kidney Injury on Ventilator Initiation Day Independently Predicts Prolonged Mechanical Ventilation in Intensive Care Unit Patients

Pan, Shiann; Kao, Hsin-Kuo; Lien, Te-Cheng; Chen, Yen‐Wen; Kou, Yu Ru; Wang, Jia-Horng

doi:10.1097/01.sa.0000415516.50663.42

Cited by 8 publications

(13 citation statements)

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“…Both acute kidney injury and elevated BUN have been identified as independent risk factors for prolonged mechanical ventilation and weaning failure. [27][28][29][30] The results of these earlier studies support our findings that increased BUN was an independent risk factor for re-intubation.…”

Section: Discussionsupporting

confidence: 82%

“…22,[24][25][26] The high mortality seen in critically ill patients with renal failure has been attributed to the need for mechanical ventilation, 27 and renal failure per se has been identified as an independent risk factor for prolonged mechanical ventilation and weaning failure. [27][28][29][30] In surgical patients, the etiologies leading to tracheal intubation and mechanical ventilation might, in some aspect, differ from those of medical patients. We recently developed and validated the score for prediction of postoperative respiratory complications.…”

Section: Introductionmentioning

confidence: 99%

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Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

et al. 2015

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BACKGROUND: Re-intubation is associated with high morbidity and mortality. There is limited information regarding the risk factors that predispose patients admitted to the surgical ICU to re-intubation. We hypothesized that preoperative comorbidities, acquired muscular weakness, and renal dysfunction would be predictors of re-intubation in the surgical ICU population. METHODS: This was a prospective observational study in 2 surgical ICUs of a large tertiary hospital. All patients who were extubated during their surgical ICU stay were included. Demographic and clinical data were collected before and after extubation. The primary outcome was re-intubation within 72 h. Using multivariate logistic regression analysis, independent risk factors of re-intubation were determined, and a prediction score was developed. RESULTS: Between December 1, 2012, and January 31, 2014, we included 764 consecutive subjects. Of these, 65 subjects (8.5%) required re-intubation. Independent risk factors of re-intubation were blood urea nitrogen level of >8.2 mmol/L (odds ratio [OR] 3.66, 95% CI 1.97-6.80), hemoglobin level of <75 g/L (OR 2.10, 95% CI 1.23-3.61), and muscle strength of <3 (OR 2.03, 95% CI 1.16 -3.55). The presence of all 3 risk factors was associated with an estimated probability for re-intubation of 26.8%. CONCLUSIONS: In noncardiac surgery, surgical ICU subjects, elevated blood urea nitrogen level, low hemoglobin level, and muscle weakness were identified as independent risk factors for re-intubation. The presence of these risk factors can potentially aid clinicians in making informed decisions regarding optimal airway management in patients considered for an extubation attempt. (ClinicalTrials.gov registration NCT01967056.)

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

et al. 2015

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“…19 AKI complicating pre-existing respiratory failure has been associated with a prolonged need for mechanical ventilation, longer duration of weaning, and longer ICU stay. 23,24 Finally, AKI has been shown in multiple studies to be a risk factor for increased mortality in patients with respiratory failure, 23,25 with one study of acute respiratory distress syndrome (ARDS) patients documenting that AKI is associated with a doubling of mortality compared with non-AKI patients. 25 The relationship between kidney injury and lung injury may be bidirectional because mechanical ventilation appears to be a risk factor for the development of AKI.…”

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confidence: 99%

Pulmonary Consequences of Acute Kidney Injury

Teixeira

Ambruso

Griffin

et al. 2019

Seminars in Nephrology

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Mortality rates among critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy typically exceed 50%, rates that have not improved significantly despite ongoing advancements in renal replacement therapy. A growing body of animal and human data have accumulated over the past 2 decades that have shown that AKI is associated with a series of distant organ effects that may contribute to the persistently high mortality of AKI. In this review, we describe the pulmonary sequelae of AKI, focusing on mechanisms of pulmonary edema in the context of traditional complications of AKI (eg, volume overload, acidosis) and nontraditional complications of AKI (eg, systemic inflammation). We review the complexities of volume management in patients with kidney and lung injury and subsequently delve into the clinical and basic science data on the mediators of lung injury after AKI. With an in-depth understanding of how the traditional and nontraditional effects of AKI can combine to produce pulmonary complications, effective management and therapeutic strategies may be developed.

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“…29 AKI on the day of mechanical ventilation initiation was an independent risk factor for prolonged mechanical ventilation, in addition to longer mechanical ventilation duration before readiness for weaning and a higher rapid shallow breathing index. 30 Respiratory failure frequently observed in patients with sepsis is presumably caused by systemic arterial vasodilation, vascular leakage, and subsequent pulmonary edema. Volume overload caused by AKI will amplify lung injury, which could be prevented by removing excess extracellular fluid.…”

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confidence: 99%

Impact of acute kidney injury on distant organ function: recent findings and potential therapeutic targets

Doi

Rabb

2016

Kidney International

191

135

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Acute kidney injury (AKI) is a common complication in critically ill patients and subsequently worsens outcomes. Although many drugs to prevent and treat AKI have shown benefits in preclinical models, no specific agent has been shown to benefit AKI in humans. Moreover, despite remarkable advances in dialysis techniques that enable management of AKI in hemodynamically unstable patients with shock, dialysis-requiring severe AKI is still associated with an unacceptably high mortality rate. Thus, focusing only on kidney damage and loss of renal function has not been sufficient to improve outcomes of patients with AKI. Recent data from basic and clinical research have begun to elucidate complex organ interactions in AKI between kidney and distant organs, including heart, lung, spleen, brain, liver, and gut. This review serves to update the topic of organ cross talk in AKI and focuses on potential therapeutic targets to improve patient outcomes during AKI-associated multiple organ failure.

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Acute Kidney Injury on Ventilator Initiation Day Independently Predicts Prolonged Mechanical Ventilation in Intensive Care Unit Patients

Cited by 8 publications

References 0 publications

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

Pulmonary Consequences of Acute Kidney Injury

Impact of acute kidney injury on distant organ function: recent findings and potential therapeutic targets

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