Timing of Renal Support and Outcome of ...
Document type :
Article dans une revue scientifique
PMID :
Permalink :
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]
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
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 >
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
Université de Lille
CHU Lille
Research team(s) :
Fungal associated invasive and inflammatory diseases
Submission date :
2019-03-01T14:46:28Z
2024-01-26T16:40:23Z
2024-01-26T16:40:23Z