Acute and Critical Care

Original Article

Pulmonary
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: Pierre Basse, Louis Morisson, Romain Barthélémy, Nathan Julian, Manuel Kindermans, Magalie Collet, Benjamin Huot, Etienne Gayat, Alexandre Mebazaa, Benjamin G. Chousterman; Acute Crit Care. 2023;38(2):172-181. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01494

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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.

Citations

Citations to this article as recorded by

Bidirectional pressure: a mini review of ventilator-lung-kidney interactions
Avnee Kumar, Katie Epler, Sean DeWolf, Laura Barnes, Mark Hepokoski
Frontiers in Physiology.2024;[Epub] CrossRef

Case Report

Intraoperative Fluid Management in Combined Liver-Kidney Transplantation: Jong Hae Kim, Bo Reum Lim, Jin Yong Jung; Korean J Crit Care Med. 2013;28(4):309-313.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.309

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Abstract PDF

A review of the literature regarding combined liver-kidney transplantation (CLKT) does not provide adequate central venous pressure (CVP) values that would allow for unimpaired hepatic venous outflow and early renal allograft diuresis during the procedure. We report a case of fluid management of CLKT based on the limited literature available in a 59-year-old male with liver cirrhosis and end-stage renal disease. During the preanhepatic phase, CVP was maintained at 5 mmHg. Following portal vein clamping, CVP was reduced to below 5 mmHg until venovenous bypass was initiated. From the neohepatic phase to 1 hour before renal allograft reperfusion, CVP was slowly increased to 10 mmHg. Within an hour before renal allograft reperfusion, maximal crystalloid hydration was used to increase CVP to 15 mmHg. The urine output was replaced to maintain CVP at 8 to 10 mmHg until the end of the surgery. The postoperative course was uneventful. In conclusion, fluid management tailored to each phase yielded beneficial results in a patient with CLKT.

Citations

Citations to this article as recorded by

Combined liver and kidney transplantation: Our experience and review of literature
KusumaRamachandra Halemani, N Bhadrinath
Indian Journal of Anaesthesia.2017; 61(1): 68. CrossRef

Original Article

Effect of Positive End-Expiratory Pressure on Intraocular Pressure in the Critically Ill and Mechanically Ventilated Patients: Ju Tae Sohn, Heon Young Ahn, Ji Hong Bae, Heon Keun Lee, Sang Hwy Lee, Young Kyun Chung; Korean J Crit Care Med. 1997;12(2):151-158.

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Abstract PDF: BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation.
METHODS
Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order.
RESULTS
IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed.
CONCLUSIONS
The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.

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