A pilot feasibility study of continuous cardiac output and blood pressure monitoring during intermittent hemodialysis in patients recovering from severe acute kidney injury

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-04-13 DOI:10.1016/j.jcrc.2025.155086

Sofia Spano , Akinori Maeda , Joey Lam , Anis Chaba , Atthaphong Phongphithakchai , Yukiko Hikasa , Nuttapol Pattamin , Nuanprae Kitisin , Emily See , Peter Mount , Rinaldo Bellomo

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Abstract

Purpose

To detect changes in cardiac output and blood pressure during intermittent hemodialysis (IHD) in patients recovering from severe acute kidney injury (AKI) after transition from continuous renal replacement therapy (CRRT).

Material and methods

In this single-center pilot feasibility study, we applied continuous hemodynamic monitoring (ClearSight System™) before and during IHD sessions in patients recovering from severe AKI. We also measured relative blood volume (BV; CRIT-LINE®IV) and Net Ultrafiltration Rate (NUF). CI changes were categorized as follows: Increase (>5 %), Stable (−5 % to 5 %), Mild Decrease (−5 % to −15 %), Moderate Decrease (−15 % to −25 %), and Severe Decrease (<−25 %).

Results

We enrolled 10 AKI patients. Overall, there were 119 episodes of severe and 286 episodes of moderate reductions in cardiac index (CI). The median time spent with severe and moderate intradialytic reductions in CI was 8.2 min [2.1–115.8] and 49.5 min [21.6–57.5], respectively. Severe CI reductions happened in nine patients out of 10, and in three patients, they lasted more than 2 h. During IHD, mean arterial pressure increased or remained stable in >78 % of measurements, regardless of changes in CI. Overall, CI decreased by −1.14 L/min/m² during a moderate BV decrease (p < 0.001) and by −0.57 L/min/m² when NUF rate was high (p < 0.001).

Conclusions

CI often, repeatedly, and markedly decreased during IHD. Such decreases were not detected by MAP monitoring and were extreme in some patients.

Abstract Image

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重度急性肾损伤恢复期间歇血液透析患者持续心输出量和血压监测的初步可行性研究

目的检测间歇性血液透析（IHD）期间，从连续性肾脏替代治疗（CRRT）转为严重急性肾损伤（AKI）恢复期患者的心输出量和血压的变化。材料和方法在这项单中心试点可行性研究中，我们在严重 AKI 恢复期患者的 IHD 治疗前和治疗期间应用了连续血流动力学监护仪（ClearSight System™）。我们还测量了相对血容量（BV；CRIT-LINE®IV）和净超滤率（NUF）。CI 变化分类如下：结果我们招募了 10 名 AKI 患者。总体而言，心脏指数（CI）严重下降 119 次，中度下降 286 次。肾内CI重度和中度下降的中位时间分别为8.2分钟[2.1-115.8]和49.5分钟[21.6-57.5]。10 名患者中有 9 名出现 CI 严重下降，3 名患者持续时间超过 2 小时。总体而言，在 BV 中度下降时，CI 下降-1.14 升/分钟/平方米（p <0.001），在 NUF 率较高时，CI 下降-0.57 升/分钟/平方米（p <0.001）。结论在心肌缺血时，CI 经常反复明显下降，而 MAP 监测无法检测到这种下降，在某些患者中甚至达到了极致。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.