Interacción entre el sistema respiratorio y renal durante la ventilación mecánica

Abstract

In critically ill patients with lung-induced kidney injury or ventilator-induced kidney injury, several factors are described that may contribute to their development. The inflammatory response generated from an injured lung with hypoxemia and hypercapnia producing hemodynamic changes at the renal level with the subsequent drop in glomerular filtration. During mechanical ventilation the above phenomena are usually magnified, the positive intrathoracic pressure and intra-abdominal pressure generated by mechanical ventilation can affect renal hemodynamics, and thus reduce blood flow and glomerular filtration. In addition, a greater inflammatory response triggered by mechanical ventilation, with elevated levels of proinflammatory cytokines, influences acute kidney injury (AKI). Among ventilatory parameters, studies suggest that increases in positive end-expiratory pressure (PEEP) and tidal volume (Vc) and a reduction in compliance of the respiratory system are related to the development of ventilator-induced kidney injury, although there are discrepancies in some findings. As a result of the above, management guidelines have been generated for lung-kidney interaction in critically ill patients with ventilator-induced kidney injury, such as compliance with the KDIGO guidelines; conservative fluid management, monitoring of clinical variables such as serum creatinine, urinary output, ventilatory monitoring with the aim of protective ventilation, and treating complications such as hypotension, venous congestion, right heart failure and intra-abdominal hypertension, as they may contribute to greater kidney dysfunction. The importance of understanding and addressing the interaction between the lungs and kidneys in critically ill patients may improve clinical outcomes.