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Predicting intradialytic hypotension in critically ill patients undergoing intermittent hemodialysis: a prospective observational study.
da Hora Passos, Rogério; Coelho, Fernanda Oliveira; Caldas, Juliana Ribeiro; Dosde Santos GalvãoMelo, Erica Batista; de Carvalho Farias, Augusto Manoel; Messeder, Octávio Henrique Coelho; Macedo, Etienne.
Afiliação
  • da Hora Passos R; Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, Av Albert Einstein, 627/701, Morumbi, São Paulo, SP, Brazil. oiregorpassos@yahoo.com.br.
  • Coelho FO; Davita Tratamento Renal, Rio de Janeiro, Brazil. oiregorpassos@yahoo.com.br.
  • Caldas JR; Davita Tratamento Renal, Rio de Janeiro, Brazil.
  • Dosde Santos GalvãoMelo EB; Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
  • de Carvalho Farias AM; Hospital São Rafael, Salvador, Brazil.
  • Messeder OHC; Hospital Português, Salvador, Brazil.
  • Macedo E; Hospital Português, Salvador, Brazil.
Intensive Care Med Exp ; 12(1): 82, 2024 Sep 27.
Article em En | MEDLINE | ID: mdl-39331284
ABSTRACT

BACKGROUND:

Hypotension during dialysis arises from vasomotor tone alterations and hypovolemia, with disrupted counterregulatory mechanisms in acute kidney injury (AKI) patients. This study investigated the predictive value of preload dependency, assessed by the passive leg raising (PLR) test, and arterial tone, measured by dynamic elastance (Eadyn), for intradialytic hypotension (IDH).

METHODS:

In this prospective observational study conducted in a tertiary hospital ICU, hemodynamic parameters were collected from critically ill AKI patients undergoing intermittent hemodialysis using the FloTrac/Vigileo system. Baseline measurements were recorded before KRT initiation, including the PLR test and Eadyn calculation. IDH was defined as mean arterial pressure (MAP) < 65 mmHg during dialysis. Logistic regression was used to identify predictors of IDH, and Kaplan-Meier analysis assessed 90-day survival.

RESULTS:

Of 187 patients, 27.3% experienced IDH. Preload dependency, identified by positive PLR test, was significantly associated with IDH (OR 8.54, 95% CI 5.25-27.74), while baseline Eadyn was not predictive of IDH in this cohort. Other significant predictors of IDH included norepinephrine use (OR 16.35, 95% CI 3.87-68.98) and lower baseline MAP (OR 0.96, 95% CI 0.94-1.00). IDH and a positive PLR test were associated with lower 90-day survival (p < 0.001).

CONCLUSIONS:

The PLR test is a valuable tool for predicting IDH in critically ill AKI patients undergoing KRT, while baseline Eadyn did not demonstrate predictive value in this setting. Continuous hemodynamic monitoring, including assessment of preload dependency, may optimize patient management and potentially improve outcomes. Further research is warranted to validate these findings and develop targeted interventions to prevent IDH.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Intensive Care Med Exp Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Alemanha
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Intensive Care Med Exp Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Alemanha