Τίτλος:
Microcirculatory alterations during continuous renal replacement therapy in ICU: A novel view on the ‘dialysis trauma’ concept
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objective The purpose of this study was to evaluate microcirculation over 24 h renal replacement therapy (CRRT) in critically ill patients. Methods We conducted a single-center, prospective, observational study, measuring microcirculation parameters, monitored by near infrared spectroscopy (NIRS) before hemodiafiltration onset (H0), and at six (H6) and 24 h (H24) during CRRT in critically ill patients. Serum Cystatin C (sCysC) and soluble (s)E-selectin levels were measured at the same time points. Twenty-eight patients [19 men (68%)] were included in the study. Results Tissue oxygen saturation (StO2, %) [76.5 ± 12.5 (H0) vs 75 ± 11 (H6) vs 70 ± 16 (H24), p = 0.04], reperfusion rate, indicating endothelial function (EF, %/sec) [2.25 ± 1.44 (H0) vs 2.1 ± 1.8 (H6) vs 1.6 ± 1.4 (H24), p = 0.02] and sCysC (mg/L) [2.7 ± 0.8 (H0) vs 2.2 ± 0.6 (H6) vs 1.8 ± 0.8 (H24), p < 0.0001] significantly decreased within the 24 h CRRT. Change of EF positively correlated with changes of sCysC within 24 h CRRT (r = 0.464, p = 0.013) while in patients with diabetes the change of StO2 correlated with dose (r = − 0.8, p = 0.01). No correlation existed between hemoglobin and temperature changes with the deteriorated microcirculation indices. sE-Selectin levels in serum were elevated; no difference was established over the 24 h CRRT period. A strong correlation existed between the sE-Selectin concentration change at H6 and H24 and the mean arterial pressure change in the same period (r = 0.77, p < 0.001). Conclusions During the first 24 h of CRRT implementation in critically ill patients, deterioration of microcirculation parameters was noted. Microcirculatory alterations correlated with sCysC changes and with dose in patients with diabetes. © 2015 Elsevier Inc.
Συγγραφείς:
Pipili, C.
Vasileiadis, I.
Grapsa, E.
Tripodaki, E.-S.
Ioannidou, S.
Papastylianou, A.
Kokkoris, S.
Routsi, C.
Politou, M.
Nanas, S.
Περιοδικό:
Microvascular Research
Εκδότης:
Academic Press Inc.
Λέξεις-κλειδιά:
cystatin C; endothelial leukocyte adhesion molecule 1; hemoglobin; biological marker; CST3 protein, human; cystatin C; endothelial leukocyte adhesion molecule 1; oxygen; SELE protein, human, aged; Article; body temperature disorder; clinical article; clinical trial; continuous hemodiafiltration; continuous renal replacement therapy; critically ill patient; diabetes mellitus; dose; down regulation; female; human; intensive care unit; kidney perfusion; male; mean arterial pressure; microangiopathy; microcirculation; near infrared spectroscopy; observational study; oxygen saturation; oxygen tissue level; priority journal; prospective study; protein blood level; reperfusion; therapy effect; upregulation; adverse effects; arterial pressure; blood; blood flow; blood flow velocity; critical illness; Greece; hand; hemodiafiltration; Kidney Diseases; microcirculation; middle aged; pathophysiology; pilot study; procedures; skeletal muscle; time factor; treatment outcome; vascularization, Aged; Arterial Pressure; Biomarkers; Blood Flow Velocity; Critical Illness; Cystatin C; E-Selectin; Female; Greece; Hand; Hemodiafiltration; Humans; Intensive Care Units; Kidney Diseases; Male; Microcirculation; Middle Aged; Muscle, Skeletal; Oxygen; Pilot Projects; Prospective Studies; Regional Blood Flow; Spectroscopy, Near-Infrared; Time Factors; Treatment Outcome
DOI:
10.1016/j.mvr.2015.09.004
