The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients

Garzotto, Francesco; Ostermann, Marlies; Martín-Langerwerf, David; Sánchez-Sánchez, Manuel; Teng, Jie; Robert, René; Marinho, A.; Herrera-Gutiérrez, M.E.; Mao, Huijuan; Benavente, David; Kipnis, Éric; Lorenzin, Anna; Marcelli, Daniele; Tetta, Ciro; Ronco, Claudio

doi:10.1186/s13054-016-1355-9

Cited by 132 publications

(93 citation statements)

References 26 publications

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“…In critically ill patients, apparently excessive fluid overload has a negative association with outcome [16,17] . Such fluid overload appears physiologically undesirable and may participate in the pathogenesis of several clinically important complications like impaired wound healing, prolonged mechanical ventilation, and risk for pulmonary edema [18] .…”

Section: Relationship With Previous Studiesmentioning

confidence: 99%

Perioperative Hemodynamic Instability and Fluid Overload are Associated with Increasing Acute Kidney Injury Severity and Worse Outcome after Cardiac Surgery

Haase-Fielitz

Haase²,

Bellomo

et al. 2017

Blood Purif

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Purpose: The study aimed to investigate patients' characteristics, fluid and hemodynamic management, and outcomes according to the severity of cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: In a single-center, prospective cohort study, we enrolled 282 adult cardiac surgical patients. In a secondary analysis, we assessed preoperative patients' characteristics, physiological variables, and medication for intra- and postoperative fluid and hemodynamic management and outcomes according to CSA-AKI stages by the Renal risk, Injury, Failure, Loss, End-stage renal disease (RIFLE) classification. Variables of fluid and hemodynamic management were further assessed with regard to the need for postoperative renal replacement therapy (RRT) and in-hospital mortality by the area under the curve for the receiver operating characteristic (AUC-ROC) and multivariate regression analysis. Results: Patients with worsening RIFLE stage, were significantly older, had lower estimated glomerular filtration rate and higher body mass index, more peripheral vascular and chronic obstructive pulmonary disease, atrial fibrillation, and prolonged duration of cardiopulmonary bypass (all p < 0.01). Patients with more severe AKI stage stayed longer in the intensive care and hospital, had higher in-hospital mortality, and requirement for RRT (all p < 0.001). Also, with worsening RIFLE stage, patients had lower intraoperative mean arterial pressure (MAP); p = 0.047, despite higher doses of norepinephrine (p < 0.001). The intraoperative MAP showed the best discriminatory ability (AUC-ROC: >0.8) for and was independently associated with RRT and in-hospital mortality. Moreover, with increasing AKI severity, patients received significantly more fluid infusion, and required higher dose of furosemide; nonetheless, they had increased postoperative fluid balance. Conclusions: In this cohort, reduced MAP and increased fluid balance were independently associated with increased mortality and need for RRT after cardiac surgery.

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Section: Relationship With Previous Studiesmentioning

confidence: 99%

Perioperative Hemodynamic Instability and Fluid Overload are Associated with Increasing Acute Kidney Injury Severity and Worse Outcome after Cardiac Surgery

Haase-Fielitz

Haase²,

Bellomo

et al. 2017

Blood Purif

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“…Fluids lead to harm unless; 1) the tissue hypoxia results from inadequate oxygen delivery rather than mitochondrial or microvascular dysfunction and 2) fluid administration leads to an increase in tissue oxygen delivery (1,2,3). Prior debates and investigations have focused on optimal methods for differentiating between states of inadequate oxygen delivery and mitochondrial dysfunction (4,5,6).…”

mentioning

confidence: 99%

COUNTERPOINT: Should Acute Fluid Resuscitation Be Guided Primarily by Inferior Vena Cava Ultrasound for Patients in Shock? No

Kory

2017

CHEST

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“…The lack of these stages of AKI may limit the generalizability of trajectory-based findings to a trauma population with severe AKI. Fourth, previous studies have compared patients with and without AKI and have found an association with fluid accumulation and mortality in AKI [34, 35]. While most patients in the study were likely vigorously hydrated early in their ICU care, in accordance with ICU practice, we lacked accurate fluid balance data.…”

Section: Discussionmentioning

confidence: 98%

Acute kidney injury subphenotypes based on creatinine trajectory identifies patients at increased risk of death

et al. 2016

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BackgroundAcute kidney injury (AKI) is common among intensive care unit (ICU) patients. AKI is highly heterogeneous, with variable links to poor outcomes. Current approaches to classify AKI severity and identify patients at highest risk for poor outcomes focus on the maximum change in serum creatinine (SCr) values. However, these scores are hampered by the need for a reliable baseline SCr value and the absence of a component differentiating transient from persistent rises in SCr. We hypothesized that identification of resolving or nonresolving AKI subphenotypes based on the early trajectory of SCr values in the ICU would better differentiate patients at risk of hospital mortality.MethodsWe performed a secondary analysis of two prospective studies of ICU patients admitted to a trauma ICU (group 1; n = 1914) or general medical-surgical ICUs (group 2; n = 1867). In group 1, we tested definitions for resolving and nonresolving AKI subphenotypes and selected the definitions resulting in subphenotypes with the greatest separation in risk of death relative to non-AKI controls. We applied this definition to group 2 and tested whether the subphenotypes were independently associated with hospital mortality after adjustment for AKI severity.ResultsAKI occurred in 46% and 69% of patients in groups 1 and 2, respectively. In group 1, a resolving AKI subphenotype (defined as a decrease in SCr of 0.3 mg/dl or 25% from maximum in the first 72 h of study enrollment) was associated with a low risk of death. A nonresolving AKI subphenotype (defined as all AKI cases not meeting the “resolving” definition) was associated with a high risk of death. In group 2, the resolving AKI subphenotype was not associated with increased mortality (relative risk [RR] 0.86, 95% CI 0.63–1.17), whereas the nonresolving AKI subphenotype was associated with higher mortality (RR 1.68, 95% CI 1.15–2.44) even after adjustment for AKI severity stage.ConclusionsThe trajectory of SCr levels identifies AKI subphenotypes with different risks for death, even among AKI cases of similar severity. These AKI subphenotypes might better define the patients at risk for poor outcomes who might benefit from novel interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1546-4) contains supplementary material, which is available to authorized users.

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The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients

Cited by 132 publications

References 26 publications

Perioperative Hemodynamic Instability and Fluid Overload are Associated with Increasing Acute Kidney Injury Severity and Worse Outcome after Cardiac Surgery

Perioperative Hemodynamic Instability and Fluid Overload are Associated with Increasing Acute Kidney Injury Severity and Worse Outcome after Cardiac Surgery

COUNTERPOINT: Should Acute Fluid Resuscitation Be Guided Primarily by Inferior Vena Cava Ultrasound for Patients in Shock? No

Acute kidney injury subphenotypes based on creatinine trajectory identifies patients at increased risk of death

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