Near-infrared spectroscopy parameters in patients undergoing continuous venovenous hemodiafiltration.

Renato Carneiro De Freitas Chaves,Letícia Bagatini Meneghini,Miguel Cendoroglo,Philipe Franco Do Amaral Tafner,Oscar Fernando Pavão Dos Santos,Thiago Domingos Corrêa,Felipe Ko Chen,Ary Serpa,Roberto Rabello

doi:10.31744/einstein_journal/2019ao4439

Renato Carneiro De Freitas Chaves, Letícia Bagatini Meneghini + Show 7 more

Open Access

https://doi.org/10.31744/einstein_journal/2019ao4439

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Abstract

ABSTRACTObjective To investigate the impacts of continuous venovenous hemodiafiltration on the microcirculation in patients with acute kidney injury.Methods A prospective observational pilot study conducted in a 40-bed, open clinical-surgical intensive care unit of a private tertiary care hospital located in the city of São Paulo (SP), Brazil. Microcirculation was assessed using near-infrared spectroscopy by means of a 15mm probe placed over the thenar eminence. Vascular occlusion test was performed on the forearm to be submitted to near-infrared spectroscopy by inflation of a sphygmomanometer cuff to 30mmHg higher than the systolic arterial pressure. The primary endpoint was the assessment of near-infrared spectroscopy-derived parameters immediately before, 1, 4 and 24 hours after the initiation of continuous venovenous hemodiafiltration.Results Nine patients were included in this pilot study over a period of 2 months. Minimum tissue oxygen saturation measured during the vascular occlusion test was the only near-infrared spectroscopy-derived parameter to differed over the time (decrease compared to baseline values up to 24 hours after initiation of continuous venovenous hemodiafiltration).Conclusion The impacts of microcirculatory dysfunction on clinical outcomes of patients undergoing to continuous venovenous hemodiafiltration need to be further investigated.

Highlights

Acute kidney injury (AKI) is a frequent complication in critically ill patients, associated with increased morbidity and mortality.(1) Renal replacement therapy (RRT) is sometimes needed to control azotemia, fluid balance and electrolyte and acid-base imbalances; it is a cornerstone of treatment in more severe cases.(2) controversial, continuous RRT (CRRT) has become a routine therapy for AKI in many countries, given the lower hemodynamic compromise and higher renal recovery rates compared to intermittent hemodialysis.(2)The impact of different therapeutic interventions on the microcirculation of critically ill patients has been reported.(3) Microcirculatory dysfunction has been associated with worse outcomes in septic shock patients(4) and others.(3) Microcirculatory dysfunction may translate into worse outcomes in patients submitted to RRT
The impacts of microcirculatory dysfunction on clinical outcomes of patients undergoing to continuous venovenous hemodiafiltration need to be further investigated
Minimum tissue oxygen saturation measured during the vascular occlusion test was the only nearinfrared spectroscopy-derived parameter to change during the first 24 hours of continuous venovenous hemodiafiltration

Summary

Introduction

The impact of different therapeutic interventions on the microcirculation of critically ill patients has been reported.(3) Microcirculatory dysfunction has been associated with worse outcomes in septic shock patients(4) and others.(3) Microcirculatory dysfunction may translate into worse outcomes in patients submitted to RRT. In these patients, CRRT may be used to mitigate dysfunction due to higher hemodynamic stability and maintenance of sufficient perfusion pressure in the course of therapy. Only one study assessing microcirculatory changes associated with RRT in patients with AKI has been published to date.(5)

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Conclusion