Extravascular lung water monitoring of renal replacement therapy in lung water scavenging for septic acute kidney injury

Han Liu; Ying Liu; Jia-Kui Sun; Qiao-Lian Xu; Ying Yan; Yong-Ming Chen; Liang Hong; Huan Xu

Extravascular lung water monitoring of renal replacement therapy in lung water scavenging for septic acute kidney injury

Int J Clin Exp Med. 2015 Oct 15;8(10):18907-16. eCollection 2015.

Authors

Han Liu¹, Ying Liu¹, Jia-Kui Sun¹, Qiao-Lian Xu¹, Ying Yan², Yong-Ming Chen¹, Liang Hong¹, Huan Xu¹

Affiliations

¹ Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University Nanjing 210006, China.
² Blood Purification Center, Nanjing First Hospital, Nanjing Medical University Nanjing 210006, China.

PMID: 26770515
PMCID: PMC4694415

Abstract

This study aims to investigate the extravascular lung water index (EVLWI) in lung water scavenging of sepsis patients with acute kidney injury (AKI) by renal replacement therapy (RRT). 57 septic acute kidney injury patients with EVLWI > 7 ml/kg were selected and randomly divided into two groups: the treatment group with continued RRT for 24 h per day, the control group with RRT for ≤8 h per day. Fluid resuscitation and RRT were performed simultaneously. After fluid resuscitation, EVLWI, hemodynamics, oxygenation index, blood lactate, and intensive care unit (ICU) stay were determined. The values of EVLWI, pulmonary vascular permeability index (PVPI), and blood lactate decreased and the intrathoracic blood volume index (ITBVI) increased significantly at 24 h, 48 h and 72 h, after RRT, compared with those before RRT in the two groups (P < 0.05). The values of EVLWI at 48 h and 72 h after RRT in the treatment group were significantly lower than that in the control group (P < 0.05). The cardiac index (CI) at 48 h and 72 h after RRT in the treatment group was significantly higher than that before RRT (P < 0.05). The values of PVPI, ITBVI, CI, blood lactate, transcutaneous oxygen saturation pulse (SPO2), oxygenation index (PO2/FiO2) and arterial oxygen (PO2) before and 24 h, 48 h, and 72 h after RRT. The 28d mortality had no significant difference in the two groups (P > 0.05). The average ICU stay for the treatment group was significantly shorter than that of the control group (P < 0.05). EVLWI monitoring of septic patients with AKI in RRT time had clinical reference value.

Keywords: Sepsis; acute kidney injury; extravascular lung water index; fluid resuscitation; pulse indicating continuous cardiac output; renal replacement therapy.