Document Type : Original Article
Authors
1
Department of Intensive Care Medicine, Tehran University of Medical Sciences, Tehran, Iran
2
Department of Critical Care Medicine, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3
Iran Helal Institute of Applied-Science and Technology, Red Crescent Society of Iran, Tehran, Iran
4
CKD Research Centre, Shahid Beheshti University of Medical Science, Tehran, Iran
5
Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Science, Tehran, Iran
6
Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
7
MBBS, FICM, ICU in-charge, Department of ICU and Emergency, Shahabuddin Medical College Hospital, Dhaka, Bangladesh
8
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA
9
MBBS, MRCP, FRCP, EDIC, DA(Gold Medal) FIACM Head Critical Care, Head Accident and Emergency Swami Dayanand Hospital, New Delhi, India
Abstract
Background: Recent pieces of evidence have shown higher efficacy of continuous renal replacement therapy (CRRT) with regard to improvement of survival in critically ill patients by maintaining hemodynamic stability. The present study aimed to assess hemodynamic conditions before and after CRRT with the point-of-care approach.
Materials and Methods: The present interventional before-after study was performed on 20 critically ill patients with unstable hemodynamic status admitted to the ICU at Masih-e-Daneshvari Hospital in Tehran in 2019. They were candidate for CRRT due to acute kidney injury (AKI). The main pointed parameters for assessment before and after CRRT included heart rate, mean arterial pressure (MAP), central vein pressure (CVP), the carotid corrected flow time (FTc), carotid peak systolic velocity (PSV), inferior vena cava collapsibility (cIVC), resistive index (RI), and inferior vena cava (IVC) size and distensibility aided by ultrasonography.
Results: Regarding the changes in ultrasonography parameters after CRRT, except for carotid PSV, heart rate, and carotid area, other parameters showed a significant change. In this regard, IVC size, FTc, MAP, CVP, internal jugular vein (IJV) area, and RI all significantly decreased while IVC distensibility index significantly increased following CRRT. Similar changes were revealed in the subgroup of patients with hypotension, but in another subgroup without hypotension, the decrease in carotid PSV was also meaningful.
Conclusion: Applying CRRT in AKI patients in critically ill situations can effectively balance cardiovascular and hemodynamic parameters and thus lead to more appropriate survival.
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