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Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. ANZICS CTG, Level 3, 10 Ievers St, Carlton, VIC, 3053, Australia .
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2013 (Engelska)Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 3, s. 429-436Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

PURPOSE:

In acute kidney injury patients, metabolic acidosis is common. Its severity, duration, and associated changes in mean arterial pressure (MAP) and vasopressor therapy may be affected by the intensity of continuous renal replacement therapy (CRRT). We aimed to compare key aspects of acidosis and MAP and vasopressor therapy in patients treated with two different CRRT intensities.

METHODS:

We studied a nested cohort of 115 patients from two tertiary intensive care units (ICUs) within a large multicenter randomized controlled trial treated with lower intensity (LI) or higher intensity (HI) CRRT.

RESULTS:

Levels of metabolic acidosis at randomization were similar [base excess (BE) of -8 ± 8 vs. -8 ± 7 mEq/l; p = 0.76]. Speed of BE correction did not differ between the two groups. However, the HI group had a greater increase in MAP from baseline to 24 h (7 ± 3 vs. 0 ± 3 mmHg; p < 0.01) and a greater decrease in norepinephrine dose (from 12.5 to 3.5 vs. 5 to 2.5 μg/min; p < 0.05). The correlation (r) coefficients between absolute change in MAP and norepinephrine (NE) dose versus change in BE were 0.05 and -0.37, respectively.

CONCLUSIONS:

Overall, LI and HI CRRT have similar acid-base effects in patients with acidosis. However, HI was associated with greater improvements in MAP and vasopressor requirements (clinical trial no. NCT00221013).

Ort, förlag, år, upplaga, sidor
2013. Vol. 39, nr 3, s. 429-436
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-199863DOI: 10.1007/s00134-012-2800-0PubMedID: 23306586OAI: oai:DiVA.org:uu-199863DiVA, id: diva2:621767
Tillgänglig från: 2013-05-17 Skapad: 2013-05-17 Senast uppdaterad: 2017-12-06Bibliografiskt granskad

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