Dataset Information

Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study.

ABSTRACT:

Background

Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension.

Methods

This prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis.

Results

Intradialytic hypotension was observed in 31.9% (n =?79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n =?31) of the sessions, and overall 28-day mortality was 20.1% (n =?50). Patients were classified in four ultrasound profiles: (A) 108 with B lines >?14 and vena cava collapsibility >?11.5?mm m^-2, (B) 38 with B lines -2, (C) 36 with B lines >?14 and vena cava collapsibility Di???11.5?mm m^-2, and (D) 66 with B lines ?11.5?mm m^-2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios?=?15, p =?0.001) and with profiles B (odds ratios?=?12, p =?0.001) and C (odds ratios?=?17, p =?0.001).

Conclusion

In critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability.

SUBMITTER: da Hora Passos R

PROVIDER: S-EPMC6889608 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Publications

Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study.

da Hora Passos Rogerio R Caldas Juliana J Ramos Joao Gabriel Rosa JGR Dos Santos Galvão de Melo Erica Batista EB Ribeiro Michel Por Deus MPD Alves Maria Fernanda Coelho MFC Batista Paulo Benigno Pena PBP Messeder Octavio Henrique Coelho OHC de Carvalho de Farias Augusto Manoel AM Macedo Etienne E Rouby Jean Jacques JJ

Critical care (London, England) 20191202 1

<h4>Background</h4>Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension.<h4>Methods</h4>This prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemod ...[more]

PMID: 31791373

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Project description:BackgroundDeep vein thrombosis (DVT) is common in critically ill patients with Coronavirus disease 2019 (COVID-19) and may cause fatal pulmonary embolism (PE) prior to diagnosis due to subtle clinical symptoms. The aim of this study was to explore the feasibility of bedside screening for DVT in critically ill COVID-19 patients performed by physicians with limited experience of venous ultrasound. We further aimed to compare inflammation, coagulation and organ dysfunction in patients with and without venous thromboembolism (VTE).MethodsThis observational study included patients with COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital in Sweden and screened for DVT with proximal compression ultrasound of the lower extremities between April and July 2020. Screening was performed by ICU residents having received a short online education and one hands-on-session. Pathological screening ultrasound was confirmed by formal ultrasound whereas patients with negative screening underwent formal ultrasound on clinical suspicion. Clinical data, laboratory findings and follow-up were extracted from medical records.ResultsOf 90 eligible patients, 56 were screened by seven ICU residents with no (n = 5) or limited (n = 2) previous experience of DVT ultrasound who performed a median of 4 (IQR 2-19) examinations. Four (7.1%) patients had pathological screening ultrasound of which three (5.6%) were confirmed by formal ultrasound. None of the 52 patients with negative screening ultrasound were diagnosed with DVT during follow-up. Six patients were diagnosed with PE of which four prior to negative screening and two following negative and positive screening respectively. Patients with VTE (n = 8) had higher median peak D-dimer (24.0 (IQR 14.2-50.5) vs. 2.8 (IQR 1.7-7.2) mg/L, p = 0.004), mean peak C-reactive protein (363 (SD 80) vs. 285 (SD 108) mg/L, p = 0.033) and median peak plasma creatinine (288 (IQR 131-328) vs. 94 (IQR 78-131) μmol/L, p = 0.009) compared to patients without VTE (n = 48). Five patients (63%) with VTE received continuous renal replacement therapy compared to six patients (13%) without VTE (p = 0.005).ConclusionICU residents with no or limited experience could detect DVT with ultrasound in critically ill COVID-19 patients following a short education. VTE was associated with kidney dysfunction and features of hyperinflammation and hypercoagulation.Trial registrationClinicalTrials ID: NCT04316884 . Registered 20 March 2020.

Dataset Information

Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study.

Background

Methods

Results

Conclusion

Publications

Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study.

Similar Datasets

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