@article{ATM33195,
author = {Tacyano Tavares Leite and Cícero Abdon Malheiro Gomes and Juan Miguel Cosquillo Valdivia and Alexandre Braga Libório},
title = {Respiratory parameters and acute kidney injury in acute respiratory distress syndrome: a causal inference study},
journal = {Annals of Translational Medicine},
volume = {7},
number = {23},
year = {2019},
keywords = {},
abstract = {Background: Assess the respiratory-related parameters associated with subsequent severe acute kidney injury in mechanically ventilated patients with acute respiratory distress syndrome (ARDS).
Methods: Retrospective cohort, analyzing a large public database—Multiparameter Intelligent Monitoring in Intensive Care-III. Adult patients with at least 48 h of mechanical ventilation (MV), under volume controlled ventilation and an oxygenation index less than 300 mmHg were included.
Results: A total of 1,142 patients had complete data and were included in the final analyses. According to a causal directed acyclic graph (DAG) that included respiratory system compliance (Crs), tidal volume (Vt), driving pressure (ΔP), plateau pressure (PPlat), PEEP, PaO2 and PaCO2 as possible exposures related to severe AKI, only Crs and PEEP levels had significant causal association with severe acute kidney injury (AKI) (OR 0.90, 95% CI: 0.84–0.94 for each 5-mL/cmH2O reduction in Crs; OR, 1.05 95% CI: 1.03–1.10 for each 1-cmH2O increase of PEEP). Using mediation analysis, we examined whether any mechanical ventilation, blood gas or hemodynamic parameters could explain the effects of Csr on AKI. Only PEEP mediated the significant but small effect (less than 5%) of Csr on severe AKI. The effects of PEEP, in turn, were not mediated by any other evaluated parameter. Several sensitivity analyses with (I) need of renal replacement therapy (RRT) as an alternative outcome and (II) only patients with Vt },
issn = {2305-5847}, url = {https://atm.amegroups.org/article/view/33195}
}