Acute kidney injury (AKI) is a serious condition that affects critically ill patients admitted to the ICU. In this study, we report the association between right ventricle shape and AKI in a cohort of burn and trauma patients. This study is a retrospective review of trauma and burn patients who were admitted to our ICU between 2013 and 2016 who underwent hemodynamic transesophageal echocardiography. Left ventricular eccentricity index (LVEI) measurements were performed on still images obtained from transgastric short-axis view clips at end diastole. LVEI was used as a surrogate of right ventricular volume loading. There were 132 patients, the mean age was 50.8 years, and they were predominantly white and males. Using logistic regression and adjusting for age, race, gender, injury mechanism, and injury severity, higher LVEI was independently significantly associated with lower incidence of AKI (odds ratio 0.03, confidence interval 0.00–0.69). Higher LVEI is associated with a lower incidence of AKI in critically injured trauma and burn patients.
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References
1.
PerinelS., VincentF., LautretteA.Transient and persistent acute kidney injury and the risk of hospital mortality in critically ill patients: results of a multicenter cohort study.Crit Care Med2015; 43: e269–75.
2.
KuoG., YangS.Y., ChuangS.S.Using acute kidney injury severity and scoring systems to predict outcome in patients with burn injury.J Formos Med Assoc2016; 115: 1046–52.
3.
MenduM.L., CiocioloG.R.Jr., McLaughlinS.R.A decision-making algorithm for initiation and discontinuation of RRT in severe AKI.Clin J Am Soc Nephrol2017; 12: 228–36.
4.
RodriguezE., Arias-CabralesC., BermejoS.Impact of recurrent acute kidney injury on patient outcomes.Kidney Blood Press Res2018; 43: 34–44.
5.
SawhneyS., FraserS.D.Epidemiology of AKI: utilizing large databases to determine the burden of AKI.Adv Chron Kidney Dis2017; 24: 194–204.
6.
GidwaniU.K., GoelS.The pulmonary artery catheter in 2015: the swan and the phoenix.Cardiol Rev2016; 24: 1–13.
7.
TenaaB., GomarC., RouxC.[Serious mechanical complications associated with pulmonary artery catheters in cardiovascular and thoracic surgery].Rev Esp Anestesiol Reanim2008; 55: 487–92.
8.
PengK., LiJ., ChengH., JiF.H.Goal-directed fluid therapy based on stroke volume variations improves fluid management and gastrointestinal perfusion in patients undergoing major orthopedic surgery.Med Princ Pract2014; 23: 413–20.
9.
ReuterD.A., FelbingerT.W., SchmidtC.Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery.Intensive Care Med2002; 28: 392–8.
10.
FerradaP.Image-based resuscitation of the hypotensive patient with cardiac ultrasound: an evidence-based review.J Trauma Acute Care Surg2016; 80: 511–18.
11.
LevitovA., FrankelH.L., BlaivasM.Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part II: cardiac ultrasonography.Crit Care Med2016; 44: 1206–27.
12.
TakagakiM., IshinoK., KawadaM.Total right ventricular exclusion improves left ventricular function in patients with end-stage congestive right ventricular failure.Circulation2003; 108: II226–9.
13.
ChenC., LeeJ., JohnsonA.E.Right ventricular function, peripheral edema, and acute kidney injury in critical illness.Kidney Int Rep2017; 2: 1059–65.
14.
PuwanantS., ParkM., PopovicZ.B.Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension.Circulation2010; 121: 259–66.
15.
WatsonT., McCrackenC.E., SlesnickT.Quantitative assessment of ventricular septal contour for estimation of right ventricular pressure.Echocardiography2016; 33: 444–9; quiz 443.
16.
AbramsonD., ScaleaT.M., HitchcockR.Lactate clearance and survival following injury.J Trauma1993; 35: 584–8; discussion 588–589.
17.
ParsikiaA., BonesK., KaplanM.The predictive value of initial serum lactate in trauma patients.Shock2014; 42: 199–204.
18.
AscahK.J., KingM.E., GillamL.D.The effects of right ventricular hemodynamics on left ventricular configuration.Can J Cardiol1990: 6: 99–106.
19.
LuoC., WareD.L., ZwischenbergerJ.B.Using a human cardiopulmonary model to study and predict normal and diseased ventricular mechanics, septal interaction, and atrio-ventricular blood flow patterns.Cardiovasc Eng2007; 7: 17–31.
20.
RobinsonS.C., BowmerC.J., YatesM.S.Cardiac function in rats with acute renal failure.J Pharm Pharmacol1992; 44: 1007–14.
21.
MaoH., KatzN., KimJ.C.Implantable left ventricular assist devices and the kidney.Blood Purif2014; 37: 57–66.
22.
ErikssonM., BrattstromO., MartenssonJ.Acute kidney injury following severe trauma: risk factors and long-term outcome.J Trauma Acute Care Surg2015; 79: 407–12.
23.
BagshawS.M., GeorgeC., GibneyR.T., BellomoR.A multi-center evaluation of early acute kidney injury in critically ill trauma patients.Ren Fail2008; 30: 581–9.
24.
QuanS., PannuN., WilsonT.Prognostic implications of adding urine output to serum creatinine measurements for staging of acute kidney injury after major surgery: a cohort study.Nephrol Dial Transplant2016; 31: 2049–56.
