Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysisReportar como inadecuado




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Critical Care

, 17:R98

First Online: 27 May 2013Received: 03 December 2012Revised: 27 February 2013Accepted: 27 May 2013

Abstract

IntroductionMechanical ventilation MV is commonly regarded as a risk factor for acute kidney injury AKI in the critically ill. We investigated the strength of this association and whether settings of tidal volume Vt and positive end-expiratory pressure PEEP affect the risk for AKI.

MethodsWe performed a systematic review and meta-analysis using studies found by searching MEDLINE, EMBASE, and references in relevant reviews and articles. We included studies reporting on a relation between the use of invasive MV and subsequent onset of AKI, or comparing higher with lower Vt or PEEP and subsequent onset of AKI. All studies clearly stating that MV was initiated after onset of AKI were excluded. We extracted the proportion with and without MV and AKI. We included 31 studies on invasive MV.

ResultsThe pooled odds ratio OR for the overall effect of MV on AKI was 3.16 95% CI 2.32 to 4.28, P <0.001. Nearly all subgroups showed that MV increases the risk for AKI. The pooled OR for studies with a multivariate analysis including MV as a risk factor for AKI was 3.58 95% CI 1.85 to 6.92; P <0.001. Different settings of Vt and PEEP showed no effect.

ConclusionsInvasive MV is associated with a threefold increase in the odds of developing AKI and various Vt or PEEP settings do not modify this risk. The latter argues in favour of a haemodynamic origin of AKI during MV.

KeywordsMechanical ventilation acute kidney injury meta-analysis epidemiology risk factors AbbreviationsAKIacute kidney injury

ALIacute lung injury

AMLacute myeloid leukaemia

ARDSacute respiratory distress syndrome

CABGcoronary artery bypass grafting

CIconfidence interval

ICUintensive care unit

IVinverse variance

MDSmyelodysplastic syndrome

MVmechanical ventilation

MV+with mechanical ventilation

MV-without mechanical ventilation

NIVnon-invasive ventilation

ORodds ratio

PEEPpositive end-expiratory pressure

sCrserum creatinine

SIRSsystemic inflammatory response syndrome

STEMIST elevation myocardial infarction

Vttidal volume.

Electronic supplementary materialThe online version of this article doi:10.1186-cc12743 contains supplementary material, which is available to authorized users.

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Autor: Johannes PC van den Akker - Mahamud Egal - AB Johan Groeneveld

Fuente: https://link.springer.com/



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