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Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation

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Abstract

Rationale

Short-term hypoxemia affects diuresis and natriuresis in healthy individuals. No data are available on the impact of the mild hypoxemia levels usually tolerated in critically ill patients receiving mechanical ventilation.

Objectives

To assess the renal effects of mild hypoxemia during mechanical ventilation for acute lung injury (ALI).

Methods

Prospective, physiological study in 12 mechanically ventilated patients with ALI. Patients were studied at baseline with an arterial saturation (SaO2) of 96% [94–98] then a comparison was performed between SaO2 values of 88–90% (mild hypoxemia) and 98–99% (high oxygenation).

Main results

FiO2 was set at 0.25 [0.23–0.32] and 0.7 [0.63–0.8], respectively, to obtain SaO2 of 89 [89–90] and 99% [98–99]. Hemodynamic or respiratory parameters were not significantly affected by FiO2 levels. Compared with high oxygenation level, mild hypoxemia using low FiO2 was associated with increase in diuresis (median [interquartile range], 67 [55–105] vs. 55 [45–60] ml/h; = 0.003) and in doppler-based renal resistive index (RI) (0.78 [0.66–0.85] vs. 0.72 [0.60–0.78]; = 0.003). The 2-h calculated creatinine clearance also increased (63 [46–103] vs. 35 [30–85] ml/min; = 0.005) without change in urinary creatinine (P = 0.13). No significant change in natriuresis was observed. Half of the patients were under norepinephrine infusion and the renal response did not differ according to the presence of vasopressors.

Conclusion

In patients with ALI, mild hypoxemia related to short-term low FiO2 induce increases in diuresis and in renal RI. This latter point suggests intra-renal mechanisms that need to be further investigated.

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Fig. 1
Fig. 2

Abbreviations

RI:

Resistive index

ARDS:

Adult respiratory distress syndrome

ALI:

Acute lung injury

IQR:

Interquartile ranges

ICU:

Intensive care unit

PEEP:

Positive end-expiratory pressure

Vt:

Tidal volume

FENa:

Excreted fraction of sodium

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Acknowledgments

The authors are greatly indebted to Prof. Gerard Friedlander (Hopital Européen George Pompidou) for his helpful comments. The authors thank A. Wolfe MD for helping with the writing of this manuscript.

Author information

Correspondence to Michael Darmon.

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Darmon, M., Schortgen, F., Leon, R. et al. Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation. Intensive Care Med 35, 1031–1038 (2009). https://doi.org/10.1007/s00134-008-1372-5

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Keywords

  • Intensive care unit
  • Respiratory distress syndrome, adult
  • Urinary tract physiology
  • Renal failure, acute
  • Doppler ultrasonography