AKI 对重症监护病房 AECOPD 患者呼吸性酸中毒代谢补偿的影响。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-06-26 DOI:10.1016/j.jcrc.2024.154846

Florian Marcy MD , Katharina Goettfried , Philipp Enghard MD, PhD , Sophie K. Piper PhD , Julius Valentin Kunz MD , Tim Schroeder MD

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引用次数: 0

摘要

目的：慢性阻塞性肺疾病（AECOPD）的急性加重可导致严重的呼吸性酸中毒。代谢补偿主要通过肾脏潴留碳酸氢盐来实现。急性肾损伤（AKI）对肾脏代偿呼吸性酸中毒能力的损害程度尚不清楚：结果：278 名患者（55.8%）出现或发展为 AKI。AKI 患者的 30 天死亡率更高（14.5% 对 4.5%，p = 0.001），机械通气时间更长（中位 90 小时对 14 小时；p = 0.001），高碳酸血症酸中毒更严重（pH 值 7.23 对 7.28；pCO2 68.5 mmHg 对 61.8 mmHg）。AKI 分期较高的患者表现出较低的 HCO3-/pCO2 比率，并且没有达到预期的 HCO3- 水平。在对每位患者进行随机截距的混合模型分析中，我们分析了 pCO2（自变量）和 HCO3-（因变量）之间的关系。在更严重的 AKI 患者中观察到较低的 HCO3- 平均变化估计值：结论：AKI 会导致不良预后，并影响 ICU AECOPD 患者呼吸性酸中毒的代谢补偿。虽然缓冲剂可能有助于补偿严重的 AKI，但应谨慎使用。

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Impact of AKI on metabolic compensation for respiratory acidosis in ICU patients with AECOPD

Purpose

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can result in severe respiratory acidosis. Metabolic compensation is primarily achieved by renal retention of bicarbonate. The extent to which acute kidney injury (AKI) impairs the kidney's capacity to compensate for respiratory acidosis remains unclear.

Materials and methods

This retrospective analysis covers clinical data between January 2009 and December 2021 for 498 ICU patients with AECOPD and need for respiratory support.

Results

278 patients (55.8%) presented with or developed AKI. Patients with AKI exhibited higher 30-day-mortality rates (14.5% vs. 4.5% p = 0.001), longer duration of mechanical ventilation (median 90 h vs. 14 h; p = 0.001) and more severe hypercapnic acidosis (pH 7.23 vs. 7.28; pCO₂ 68.5 mmHg vs. 61.8 mmHg). Patients with higher AKI stages exhibited lower HCO₃⁻/pCO₂ ratios and did not reach expected HCO₃⁻ levels. In a mixed model analysis with random intercept per patient we analyzed the association of pCO₂ (independent) and HCO₃⁻ (dependent variable). Lower estimates for averaged change in HCO₃⁻ were observed in patients with more severe AKI.

Conclusion

AKI leads to poor outcomes and compromises metabolic compensation of respiratory acidosis in ICU patients with AECOPD. While buffering agents may aid compensation for severe AKI, their use should be approached with caution.

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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.