Refilling and preload dependence failed to predict cardiac index decrease during fluid removal with continuous renal replacement therapy.
Continuous renal replacement therapy
Fluid removal
Haemoconcentration
Passive leg raising
Refilling
Journal
Journal of nephrology
ISSN: 1724-6059
Titre abrégé: J Nephrol
Pays: Italy
ID NLM: 9012268
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
11
04
2022
accepted:
14
07
2022
pubmed:
20
9
2022
medline:
7
2
2023
entrez:
19
9
2022
Statut:
ppublish
Résumé
Fluid removal can reduce the burden of fluid overload after initial resuscitation. According to the Frank-Starling model, iatrogenic hypovolemia should induce a decrease in cardiac index. We hypothesized that inadequate refilling detected by haemoconcentration during fluid removal or an increase in cardiac index (CI) during passive leg raising (PLR) could predict CI decrease during mechanical fluid removal with continuous renal replacement therapy (CRRT). We conducted a single-centre prospective diagnostic accuracy study. The primary objective was to investigate the diagnostic performance of plasma protein concentration variations in detecting a CI decrease ≥ 12% during mechanical fluid removal. Secondary objective was to assess other predictive factors of CI change. The attending physician prescribed a fluid removal challenge consisting of a mechanical fluid removal challenge of 500 mL for one hour. Plasma protein concentration, haemoglobin level, PLR and transpulmonary thermodilution were done before and after the fluid removal challenge. We included 69 adult patients between December 2016 and April 2020. Sixteen patients had a significant CI decrease (23% [95% CI 14-35]). Haemoconcentration and PLR before fluid removal challenge or CI trending failed to predict CI decrease. Haemoconcentration variables, preload dependence status and CI trending failed to predict CI decrease during fluid removal challenge.
Sections du résumé
BACKGROUND
Fluid removal can reduce the burden of fluid overload after initial resuscitation. According to the Frank-Starling model, iatrogenic hypovolemia should induce a decrease in cardiac index. We hypothesized that inadequate refilling detected by haemoconcentration during fluid removal or an increase in cardiac index (CI) during passive leg raising (PLR) could predict CI decrease during mechanical fluid removal with continuous renal replacement therapy (CRRT).
METHODS
We conducted a single-centre prospective diagnostic accuracy study. The primary objective was to investigate the diagnostic performance of plasma protein concentration variations in detecting a CI decrease ≥ 12% during mechanical fluid removal. Secondary objective was to assess other predictive factors of CI change. The attending physician prescribed a fluid removal challenge consisting of a mechanical fluid removal challenge of 500 mL for one hour. Plasma protein concentration, haemoglobin level, PLR and transpulmonary thermodilution were done before and after the fluid removal challenge.
RESULTS
We included 69 adult patients between December 2016 and April 2020. Sixteen patients had a significant CI decrease (23% [95% CI 14-35]). Haemoconcentration and PLR before fluid removal challenge or CI trending failed to predict CI decrease.
CONCLUSION
Haemoconcentration variables, preload dependence status and CI trending failed to predict CI decrease during fluid removal challenge.
Identifiants
pubmed: 36121642
doi: 10.1007/s40620-022-01407-9
pii: 10.1007/s40620-022-01407-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
187-197Informations de copyright
© 2022. The Author(s) under exclusive licence to Italian Society of Nephrology.
Références
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43(3):304–377
Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C et al (2014) Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40(12):1795–1815
Frutos-Vivar F, Ferguson ND, Esteban A, Epstein SK, Arabi Y, Apezteguía C et al (2006) Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 130(6):1664–1671
Holodinsky JK, Roberts DJ, Ball CG, Blaser AR, Starkopf J, Zygun DA et al (2013) Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care Lond Engl 17(5):R249
Marik PE, Linde-Zwirble WT, Bittner EA, Sahatjian J, Hansell D (2017) Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database. Intensive Care Med 43(5):625–632
Malbrain MLNG, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ et al (2014) Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther 46(5):361–380
Monnet X, Cipriani F, Camous L, Sentenac P, Dres M, Krastinova E, et al (2016) The passive leg raising test to guide fluid removal in critically ill patients. Ann Intensive Care. 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875574/
Bitker L, Bayle F, Yonis H, Gobert F, Leray V, Taponnier R et al (2016) Prevalence and risk factors of hypotension associated with preload-dependence during intermittent hemodialysis in critically ill patients. Crit Care Lond Engl 23(20):44
Steuer RR, Leypoldt JK, Cheung AK, Senekjian HO, Conis JM (1996) Reducing symptoms during hemodialysis by continuously monitoring the hematocrit. Am J Kidney Dis Off J Natl Kidney Found 27(4):525–532
Leung KCW, Quinn RR, Ravani P, Duff H, MacRae JM (2017) Randomized crossover trial of blood volume monitoring-guided ultrafiltration biofeedback to reduce intradialytic hypotensive episodes with hemodialysis. Clin J Am Soc Nephrol 12(11):1831–1840
Rodriguez HJ, Domenici R, Diroll A, Goykhman I (2005) Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line. Kidney Int 68(2):854–861
Anguel N, Monnet X, Osman D, Castelain V, Richard C, Teboul J-L (2008) Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med 34(7):1231–1238
Bossuyt PM, Cohen JF, Gatsonis CA, Korevaar DA (2016) STARD 2015: updated reporting guidelines for all diagnostic accuracy studies. Ann Transl Med 4(4). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779779/
Huber W, Kraski T, Haller B, Mair S, Saugel B, Beitz A et al (2014) Room-temperature vs iced saline indicator injection for transpulmonary thermodilution. J Crit Care 29(6):1133.e7-1133.e14
Monnet X, Persichini R, Ktari M, Jozwiak M, Richard C, Teboul J-L (2011) Precision of the transpulmonary thermodilution measurements. Crit Care Lond Engl 15(4):R204
Monnet X, Teboul J-L (2015) Passive leg raising: five rules, not a drop of fluid! Crit Care Lond Engl 19:18
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22(7):707–710
Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120(4):c179-184
Obuchowski NA, Bullen JA (2018) Receiver operating characteristic (ROC) curves: review of methods with applications in diagnostic medicine. Phys Med Biol 63(7):07TR01
Wickham H (2016) ggplot2: elegant graphics for data analysis, 2nd edn. Springer, Cham, p 260 (Use R!)
Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez J-C et al (2011) pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform. https://doi.org/10.1186/1471-2105-12-77
doi: 10.1186/1471-2105-12-77
Sing T, Sander O, Beerenwinkel N, Lengauer T (2005) ROCR: visualizing classifier performance in R. Bioinformatics 21(20):3940–3941
Figueras J, Weil MH (1978) Blood volume prior to and following treatment of acute cardiogenic pulmonary edema. Circulation 57(2):349–355
Warren OJ, Smith AJ, Alexiou C, Rogers PLB, Jawad N, Vincent C et al (2009) The inflammatory response to cardiopulmonary bypass: part 1—mechanisms of pathogenesis. J Cardiothorac Vasc Anesth 23(2):223–231
O’Brien B, Pasic M, Kuppe H, Hetzer R, Habazettl H, Kukucka M (2011) A transapical or transluminal approach to aortic valve implantation does not attenuate the inflammatory response. Heart Surg Forum 14(2):110
Tonelli M, Astephen P, Andreou P, Beed S, Lundrigan P, Jindal K (2002) Blood volume monitoring in intermittent hemodialysis for acute renal failure. Kidney Int 62(3):1075–1080
Kron S, Leimbach T, Wenkel R, Thieme U, Kern H, Kron J (2015) Relative blood volume monitoring during renal replacement therapy in critically Ill patients with septic shock: a preliminary report. Blood Purif 40(2):133–138
Dumans-Nizard V, Nizard J, Payen D, Cholley BP (2006) Redistribution of cardiac output during hemorrhagic shock in sheep. Crit Care Med 34(4):1147–1151
Edouard AR, Degrémont AC, Duranteau J, Pussard E, Berdeaux A, Samii K (1994) Heterogeneous regional vascular responses to simulated transient hypovolemia in man. Intensive Care Med 20(6):414–420
Monnet X, Jabot J, Maizel J, Richard C, Teboul J-L (2011) Norepinephrine increases cardiac preload and reduces preload dependency assessed by passive leg raising in septic shock patients. Crit Care Med 39(4):689–694
Daugirdas JT (2001) Pathophysiology of dialysis hypotension: an update. Am J Kidney Dis Off J Natl Kidney Found 38(4 Suppl 4):S11-17
Douvris A, Zeid K, Hiremath S, Bagshaw SM, Wald R, Beaubien-Souligny W et al (2019) Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review. Intensive Care Med 45(10):1333–1346
Ganter CC, Hochuli R, Bossard M, Etter R, Takala J, Uehlinger DE et al (2012) Forced fluid removal in critically ill patients with acute kidney injury: fluid removal in inflammatory states. Acta Anaesthesiol Scand 56(9):1183–1190
De Laet I, Deeren D, Schoonheydt K, Van Regenmortel N, Dits H, Malbrain ML (2012) Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients. Ann Intensive Care 2(Suppl 1):S20
Giraud R, Siegenthaler N, Merlani P, Bendjelid K (2017) Reproducibility of transpulmonary thermodilution cardiac output measurements in clinical practice: a systematic review. J Clin Monit Comput 31(1):43–51
Perny J, Kimmoun A, Perez P, Levy B (2014) Evaluation of cardiac function index as measured by transpulmonary thermodilution as an indicator of left ventricular ejection fraction in cardiogenic shock. BioMed Res Int 2014:598029
Hamzaoui O, Monnet X, Richard C, Osman D, Chemla D, Teboul J-L (2008) Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period. Crit Care Med 36(2):434–440
Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul J-L (2003) Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 124(5):1900–1908
Yonis H, Bitker L, Aublanc M, Perinel Ragey S, Riad Z, Lissonde F et al (2017) Change in cardiac output during Trendelenburg maneuver is a reliable predictor of fluid responsiveness in patients with acute respiratory distress syndrome in the prone position under protective ventilation. Crit Care Lond Engl 21(1):295
Monnet X, Teboul J-L (2017) Transpulmonary thermodilution: advantages and limits. Crit Care Lond Engl 21(1):147
McLuckie A, Bihari D (2000) Investigating the relationship between intrathoracic blood volume index and cardiac index. Intensive Care Med 26(9):1376–1378
Nixon JV, Murray RG, Leonard PD, Mitchell JH, Blomqvist CG (1982) Effect of large variations in preload on left ventricular performance characteristics in normal subjects. Circulation 65(4):698–703
Rosner MH, Ostermann M, Murugan R, Prowle JR, Ronco C, Kellum JA et al (2014) Indications and management of mechanical fluid removal in critical illness. Br J Anaesth 113(5):764–771
Legrand M, Soussi S, Depret F (2018) Cardiac output and CVP monitoring… to guide fluid removal. Crit Care Lond Engl 22(1):89