Title :

Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome.

Author(s) :

Gaudry, Stephane [Auteur]
Hajage, David [Auteur]
Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables [ECEVE (U1123 / UMR_S_1123)]
Schortgen, Frederique [Auteur]
Martin-Lefevre, Laurent [Auteur]
Verney, Charles [Auteur]
Pons, Bertrand [Auteur]
Boulet, Eric [Auteur]
Boyer, Alexandre [Auteur]
Chevrel, Guillaume [Auteur]
Lerolle, Nicolas [Auteur]
Université d'Angers [UA]
Carpentier, Dorothee [Auteur]
De Prost, Nicolas [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Lautrette, Alexandre [Auteur]
Bretagnol, Anne [Auteur]
Mayaux, Julien [Auteur]
Nseir, Saad [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Megarbane, Bruno [Auteur]
Université Paris Diderot - Paris 7 [UPD7]
Thirion, Marina [Auteur]
Forel, Jean-Marie [Auteur]
Maizel, Julien [Auteur]
Yonis, Hodane [Auteur]
Markowicz, Philippe [Auteur]
Thiery, Guillaume [Auteur]
Tubach, Florence [Auteur]
Université Pierre et Marie Curie - Paris 6 [UPMC]
Ricard, Jean-Damien [Auteur]
Université Paris Diderot - Paris 7 [UPD7]
Dreyfuss, Didier [Auteur]
Université Paris Diderot - Paris 7 [UPD7]

Journal title :

American Journal of Respiratory and Critical Care Medicine

Abbreviated title :

Am. J. Respir. Crit. Care Med.

Volume number :

198

Publication date :

2018-07-01

ISSN :

1535-4970

Keyword(s) :

renal replacement therapy
acute kidney injury
acute respiratory distress syndrome
mechanical ventilation
septic shock

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Rationale: The optimal strategy for initiation of renal replacement therapy (RRT) in patients with severe acute kidney injury in the context of septic shock and acute respiratory distress syndrome (ARDS) is unknown. Objectives: ...
Show more >Rationale: The optimal strategy for initiation of renal replacement therapy (RRT) in patients with severe acute kidney injury in the context of septic shock and acute respiratory distress syndrome (ARDS) is unknown. Objectives: To examine the effect of an early compared with a delayed RRT initiation strategy on 60-day mortality according to baseline sepsis status, ARDS status, and severity. Methods: Post hoc analysis of the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial. Measurements and Main Results: Subgroups were defined according to baseline characteristics: sepsis status (Sepsis-3 definition), ARDS status (Berlin definition), Simplified Acute Physiology Score 3 (SAPS 3), and Sepsis-related Organ Failure Assessment (SOFA). Of 619 patients, 348 (56%) had septic shock and 207 (33%) had ARDS. We found no significant influence of the baseline sepsis status (P = 0.28), baseline ARDS status (P = 0.94), and baseline severity scores (P = 0.77 and P = 0.46 for SAPS 3 and SOFA, respectively) on the comparison of 60-day mortality according to RRT initiation strategy. A delayed RRT initiation strategy allowed 45% of patients with septic shock and 46% of patients with ARDS to escape RRT. Urine output was higher in the delayed group. Renal function recovery occurred earlier with the delayed RRT strategy in patients with septic shock or ARDS (P < 0.001 and P = 0.003, respectively). Time to successful extubation in patients with ARDS was not affected by RRT strategy (P = 0.43). Conclusions: Early RRT initiation strategy was not associated with any improvement of 60-day mortality in patients with severe acute kidney injury and septic shock or ARDS. Unnecessary and potentially risky procedures might often be avoided in these fragile populations.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Inserm
Université de Lille
CHU Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Research team(s) :

Fungal associated invasive and inflammatory diseases

Submission date :

2019-03-01T14:46:28Z
2024-01-26T16:40:23Z