Vinicius Brenner Felice1,2, Thiago Costa Lisboa3,4, Lucas Vieira de Souza1, Luana Canevese Sell1, Gilberto Friedman1,3. 1. Unidade Central de Terapia Intensiva, Complexo Hospitalar Santa Casa de Porto Alegre - Porto Alegre (RS), Brasil. 2. Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil. 3. Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil. 4. Rede Institucional de Pesquisa e Inovação em Terapia Intensiva, Complexo Hospitalar Santa Casa de Porto Alegre - Porto Alegre (RS), Brasil.
Abstract
OBJECTIVE: To evaluate renal responsiveness in oliguric critically ill patients after a fluid challenge. METHODS: We conducted a prospective observational study in one university intensive care unit. Patients with urine output < 0.5mL/kg/h for 3 hours with a mean arterial pressure > 60mmHg received a fluid challenge. We examined renal fluid responsiveness (defined as urine output > 0.5mL/kg/h for 3 hours) after fluid challenge. RESULTS: Forty-two patients (age 67 ± 13 years; APACHE II score 16 ± 6) were evaluated. Patient characteristics were similar between renal responders and renal nonresponders. Thirteen patients (31%) were renal responders. Hemodynamic or perfusion parameters were not different between those who did and those who did not increase urine output before the fluid challenge. The areas under the receiver operating characteristic curves were calculated for mean arterial pressure, heart rate, creatinine, urea, creatinine clearance, urea/creatinine ratio and lactate before the fluid challenge. None of these parameters were sensitive or specific enough to predict reversal of oliguria. CONCLUSION: After achieving hemodynamic stability, oliguric patients did not increase urine output after a fluid challenge. Systemic hemodynamic, perfusion or renal parameters were weak predictors of urine responsiveness. Our results suggest that volume replacement to correct oliguria in patients without obvious hypovolemia should be done with caution.
OBJECTIVE: To evaluate renal responsiveness in oliguric critically ill patients after a fluid challenge. METHODS: We conducted a prospective observational study in one university intensive care unit. Patients with urine output < 0.5mL/kg/h for 3 hours with a mean arterial pressure > 60mmHg received a fluid challenge. We examined renal fluid responsiveness (defined as urine output > 0.5mL/kg/h for 3 hours) after fluid challenge. RESULTS: Forty-two patients (age 67 ± 13 years; APACHE II score 16 ± 6) were evaluated. Patient characteristics were similar between renal responders and renal nonresponders. Thirteen patients (31%) were renal responders. Hemodynamic or perfusion parameters were not different between those who did and those who did not increase urine output before the fluid challenge. The areas under the receiver operating characteristic curves were calculated for mean arterial pressure, heart rate, creatinine, urea, creatinine clearance, urea/creatinine ratio and lactate before the fluid challenge. None of these parameters were sensitive or specific enough to predict reversal of oliguria. CONCLUSION: After achieving hemodynamic stability, oliguric patients did not increase urine output after a fluid challenge. Systemic hemodynamic, perfusion or renal parameters were weak predictors of urine responsiveness. Our results suggest that volume replacement to correct oliguria in patients without obvious hypovolemia should be done with caution.
Authors: Glenn Hernández; Gustavo A Ospina-Tascón; Lucas Petri Damiani; Elisa Estenssoro; Arnaldo Dubin; Javier Hurtado; Gilberto Friedman; Ricardo Castro; Leyla Alegría; Jean-Louis Teboul; Maurizio Cecconi; Giorgio Ferri; Manuel Jibaja; Ronald Pairumani; Paula Fernández; Diego Barahona; Vladimir Granda-Luna; Alexandre Biasi Cavalcanti; Jan Bakker; Glenn Hernández; Gustavo Ospina-Tascón; Lucas Petri Damiani; Elisa Estenssoro; Arnaldo Dubin; Javier Hurtado; Gilberto Friedman; Ricardo Castro; Leyla Alegría; Jean-Louis Teboul; Maurizio Cecconi; Maurizio Cecconi; Giorgio Ferri; Manuel Jibaja; Ronald Pairumani; Paula Fernández; Diego Barahona; Alexandre Biasi Cavalcanti; Jan Bakker; Glenn Hernández; Leyla Alegría; Giorgio Ferri; Nicolás Rodriguez; Patricia Holger; Natalia Soto; Mario Pozo; Jan Bakker; Deborah Cook; Jean-Louis Vincent; Andrew Rhodes; Bryan P Kavanagh; Phil Dellinger; Wim Rietdijk; David Carpio; Nicolás Pavéz; Elizabeth Henriquez; Sebastian Bravo; Emilio Daniel Valenzuela; Magdalena Vera; Jorge Dreyse; Vanessa Oviedo; Maria Alicia Cid; Macarena Larroulet; Edward Petruska; Claudio Sarabia; David Gallardo; Juan Eduardo Sanchez; Hugo González; José Miguel Arancibia; Alex Muñoz; Germán Ramirez; Florencia Aravena; Andrés Aquevedo; Fabián Zambrano; Milan Bozinovic; Felipe Valle; Manuel Ramirez; Victor Rossel; Pilar Muñoz; Carolina Ceballos; Christian Esveile; Cristian Carmona; Eva Candia; Daniela Mendoza; Aída Sanchez; Daniela Ponce; Daniela Ponce; Jaime Lastra; Bárbara Nahuelpán; Fabrizio Fasce; Cecilia Luengo; Nicolas Medel; Cesar Cortés; Luz Campassi; Paolo Rubatto; Nahime Horna; Mariano Furche; Juan Carlos Pendino; Lisandro Bettini; Carlos Lovesio; María Cecilia González; Jésica Rodruguez; Héctor Canales; Francisco Caminos; Cayetano Galletti; Estefanía Minoldo; Maria Jose Aramburu; Daniela Olmos; Nicolás Nin; Jordán Tenzi; Carlos Quiroga; Pablo Lacuesta; Agustín Gaudín; Richard Pais; Ana Silvestre; Germán Olivera; Gloria Rieppi; Dolores Berrutti; Marcelo Ochoa; Paul Cobos; Fernando Vintimilla; Vanessa Ramirez; Milton Tobar; Fernanda García; Fabricio Picoita; Nelson Remache; Vladimir Granda; Fernando Paredes; Eduardo Barzallo; Paul Garcés; Fausto Guerrero; Santiago Salazar; German Torres; Cristian Tana; José Calahorrano; Freddy Solis; Pedro Torres; Luís Herrera; Antonio Ornes; Verónica Peréz; Glenda Delgado; Alexei López; Eliana Espinosa; José Moreira; Blanca Salcedo; Ivonne Villacres; Jhonny Suing; Marco Lopez; Luis Gomez; Guillermo Toctaquiza; Mario Cadena Zapata; Milton Alonso Orazabal; Ruben Pardo Espejo; Jorge Jimenez; Alexander Calderón; Gustavo Paredes; José Luis Barberán; Tatiana Moya; Horacio Atehortua; Rodolfo Sabogal; Guillermo Ortiz; Antonio Lara; Fabio Sanchez; Alvaro Hernán Portilla; Humberto Dávila; Jorge Antonio Mora; Luis Eduardo Calderón; Ingrid Alvarez; Elena Escobar; Alejandro Bejarano; Luis Alfonso Bustamante; José Luis Aldana Journal: JAMA Date: 2019-02-19 Impact factor: 56.272
Authors: David Schnell; Laurent Camous; Stéphane Guyomarc'h; Jacques Duranteau; Emmanuel Canet; Pierre Gery; Anne-Sylvie Dumenil; Fabrice Zeni; Elie Azoulay; Michael Darmon Journal: Crit Care Med Date: 2013-05 Impact factor: 7.598