Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis

被引：26

作者：

Bellomo, Rinaldo ^{[1
]}

Lipcsey, Miklos ^{[1
]}

Calzavacca, Paolo ^{[1
]}

Haase, Michael ^{[1
]}

Haase-Fielitz, Anjia ^{[1
]}

Licari, Elisa ^{[1
]}

Tee, Augustine ^{[1
]}

Cole, Louise ^{[1
]}

Cass, Alan ^{[1
]}

Finfer, Simon ^{[1
]}

Gallagher, Martin ^{[1
]}

Lee, Joanne ^{[1
]}

Lo, Serigne ^{[1
]}

McArthur, Colin ^{[1
]}

McGuinness, Shay ^{[1
]}

Myburgh, John ^{[1
]}

Scheinkestel, Carlos ^{[1
]}

机构：

[1] ANZICS CTG, Melbourne, Vic 3053, Australia

来源：

INTENSIVE CARE MEDICINE | 2013年 / 39卷 / 03期

基金：

澳大利亚国家健康与医学研究理事会; 英国医学研究理事会;

关键词：

Acidosis; Acid-base; Acidemia; Norepinephrine; Alkalosis; Base excess; Bicarbonate; pH; Continuous renal replacement therapy; Hemodialysis; Strong ion difference; CONTINUOUS VENOVENOUS HEMOFILTRATION; HIGH-VOLUME HEMOFILTRATION; CRITICALLY-ILL PATIENTS; HUMAN SEPTIC SHOCK; CARE-UNIT; LACTIC-ACIDOSIS; FAILURE; HEMODYNAMICS; MORTALITY; ABNORMALITIES;

D O I：

10.1007/s00134-012-2800-0

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

In acute kidney injury patients, metabolic acidosis is common. Its severity, duration, and associated changes in mean arterial pressure (MAP) and vasopressor therapy may be affected by the intensity of continuous renal replacement therapy (CRRT). We aimed to compare key aspects of acidosis and MAP and vasopressor therapy in patients treated with two different CRRT intensities. We studied a nested cohort of 115 patients from two tertiary intensive care units (ICUs) within a large multicenter randomized controlled trial treated with lower intensity (LI) or higher intensity (HI) CRRT. Levels of metabolic acidosis at randomization were similar [base excess (BE) of -8 +/- A 8 vs. -8 +/- A 7 mEq/l; p = 0.76]. Speed of BE correction did not differ between the two groups. However, the HI group had a greater increase in MAP from baseline to 24 h (7 +/- A 3 vs. 0 +/- A 3 mmHg; p < 0.01) and a greater decrease in norepinephrine dose (from 12.5 to 3.5 vs. 5 to 2.5 mu g/min; p < 0.05). The correlation (r) coefficients between absolute change in MAP and norepinephrine (NE) dose versus change in BE were 0.05 and -0.37, respectively. Overall, LI and HI CRRT have similar acid-base effects in patients with acidosis. However, HI was associated with greater improvements in MAP and vasopressor requirements (clinical trial no. NCT00221013).

引用

页码：429 / 436

页数：8

共 35 条

[1]

Adrogue H E, 2001, Respir Care, V46, P328

[2] The implications of metabolic acidosis in intensive care unit patients [J].