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Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study.
Crit Care. 2019 Dec 02; 23(1):389.CC

Abstract

BACKGROUND

Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension.

METHODS

This prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis.

RESULTS

Intradialytic hypotension was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1% (n = 50). Patients were classified in four ultrasound profiles: (A) 108 with B lines > 14 and vena cava collapsibility > 11.5 mm m-2, (B) 38 with B lines < 14 and vena cava collapsibility ≤ 11.5 mm m-2, (C) 36 with B lines > 14 and vena cava collapsibility Di ≤ 11.5 mm m-2, and (D) 66 with B lines < 14 and vena cava collapsibility > 11.5 mm m-2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios = 15, p = 0.001) and with profiles B (odds ratios = 12, p = 0.001) and C (odds ratios = 17, p = 0.001).

CONCLUSION

In critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability.

Authors+Show Affiliations

Critical Care Unit and Nephrology Department, Hospital Português and Hospital São Rafael, Salvador, Bahia, Brazil. oiregorpassos@yahoo.com.br.Critical Care Unit, Hospital São Rafael, Salvador, Bahia, Brazil.Critical Care Unit, Hospital São Rafael, Salvador, Bahia, Brazil.Critical Care Unit, Hospital Português, Salvador, Bahia, Brazil. Nephrology Department, Hospital São Rafael, Salvador, Bahia, Brazil.Critical Care Unit, Hospital Português and Hospital São Rafael, Salvador, Bahia, Brazil.Nephrology Department, Hospital Português, Salvador, Bahia, Brazil.Critical Care Unit and Nephrology Department, Hospital São Rafael, Salvador, Bahia, Brazil.Critical Care Unit, Hospital Português, Salvador, Bahia, Brazil.Critical Care Unit, Hospital Português, Salvador, Bahia, Brazil.Division of Nephrology, Department of Medicine, University of California, San Diego, USA.Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University of Paris, Paris, France.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

31791373

Citation

da Hora Passos, Rogerio, et al. "Ultrasound-based Clinical Profiles for Predicting the Risk of Intradialytic Hypotension in Critically Ill Patients On Intermittent Dialysis: a Prospective Observational Study." Critical Care (London, England), vol. 23, no. 1, 2019, p. 389.
da Hora Passos R, Caldas J, Ramos JGR, et al. Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study. Crit Care. 2019;23(1):389.
da Hora Passos, R., Caldas, J., Ramos, J. G. R., Dos Santos Galvão de Melo, E. B., Ribeiro, M. P. D., Alves, M. F. C., Batista, P. B. P., Messeder, O. H. C., de Carvalho de Farias, A. M., Macedo, E., & Rouby, J. J. (2019). Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study. Critical Care (London, England), 23(1), 389. https://doi.org/10.1186/s13054-019-2668-2
da Hora Passos R, et al. Ultrasound-based Clinical Profiles for Predicting the Risk of Intradialytic Hypotension in Critically Ill Patients On Intermittent Dialysis: a Prospective Observational Study. Crit Care. 2019 Dec 2;23(1):389. PubMed PMID: 31791373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study. AU - da Hora Passos,Rogerio, AU - Caldas,Juliana, AU - Ramos,Joao Gabriel Rosa, AU - Dos Santos Galvão de Melo,Erica Batista, AU - Ribeiro,Michel Por Deus, AU - Alves,Maria Fernanda Coelho, AU - Batista,Paulo Benigno Pena, AU - Messeder,Octavio Henrique Coelho, AU - de Carvalho de Farias,Augusto Manoel, AU - Macedo,Etienne, AU - Rouby,Jean Jacques, Y1 - 2019/12/02/ PY - 2019/08/12/received PY - 2019/11/12/accepted PY - 2019/12/4/entrez PY - 2019/12/4/pubmed PY - 2019/12/4/medline KW - Acute kidney injury KW - Critically ill patients KW - Dialysis KW - Hypotension KW - Profiles KW - Ultrasound SP - 389 EP - 389 JF - Critical care (London, England) JO - Crit Care VL - 23 IS - 1 N2 - BACKGROUND: Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension. METHODS: This prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis. RESULTS: Intradialytic hypotension was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1% (n = 50). Patients were classified in four ultrasound profiles: (A) 108 with B lines > 14 and vena cava collapsibility > 11.5 mm m-2, (B) 38 with B lines < 14 and vena cava collapsibility ≤ 11.5 mm m-2, (C) 36 with B lines > 14 and vena cava collapsibility Di ≤ 11.5 mm m-2, and (D) 66 with B lines < 14 and vena cava collapsibility > 11.5 mm m-2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios = 15, p = 0.001) and with profiles B (odds ratios = 12, p = 0.001) and C (odds ratios = 17, p = 0.001). CONCLUSION: In critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/31791373/Ultrasound_based_clinical_profiles_for_predicting_the_risk_of_intradialytic_hypotension_in_critically_ill_patients_on_intermittent_dialysis:_a_prospective_observational_study_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2668-2 DB - PRIME DP - Unbound Medicine ER -