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.
Highlights
Mechanical ventilation (MV) is commonly regarded as a risk factor for acute kidney injury (AKI) in the critically ill
The study characteristics of 23 studies [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] reporting on the use of invasive MV and renal function in a total number of 10,333 patients are presented in Table 1 and Table S2 in Additional file 1
In this systematic review and meta-analysis we show that invasive MV increases the odds for AKI by a factor of three, relatively independent of diagnostic subgroups
Summary
Mechanical 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. Acute kidney injury (AKI) is - depending on the definition used - a common complication in the intensive care unit (ICU) with a high mortality, while it may adversely affect long-term survival [1]. It affects up to 29% of patients who are mechanically ventilated [2]. Studies have demonstrated that mechanical ventilation (MV) affects the kidney [4]. Kuiper et al [4] proposed that MV may lead to the development of AKI through haemodynamic factors or
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