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Impact of renal dysfunction on weaning from prolonged mechanical ventilation
Chao1, Scheinhorn, Stearn-Hassenpflug
1Barlow Respiratory Hospital, Barlow Respiratory Research Center, 2000 Stadium Way, Los Angeles, CA 90026-2696, USA. dcchao@barlow2000.org
Critical Care (London, England)
|January 1, 1997
Summary
Patients requiring mechanical ventilation and renal replacement therapy have a very poor prognosis. Even those with renal issues not needing dialysis had worse long-term survival.
Area of Science:
- Critical Care Medicine
- Nephrology
- Pulmonology
Background:
- Mechanical ventilation and renal replacement therapy (RRT) in intensive care units (ICUs) are linked to poor outcomes.
- Severe renal dysfunction complicates weaning from prolonged mechanical ventilation (PMV).
Purpose of the Study:
- To evaluate outcomes of patients with severe renal dysfunction undergoing attempted weaning from PMV.
- To compare outcomes between patients requiring RRT and those with renal insufficiency not needing RRT.
Main Methods:
- Screened 1077 patients transferred to a regional weaning center (RWC) over 8 years.
- Reviewed records of patients with serum creatinine > 2.5 mg/dl.
- Analyzed outcomes of 63 patients meeting criteria, including 40 on RRT.
Main Results:
- 84% of patients requiring PMV and RRT died during weaning attempts.
- Outcomes were significantly worse (P<0.001) than controls with serum creatinine ≤ 2.5 mg/dl.
- No RRT patient recovered renal function; long-term survival was poor, with no 1-year survivors.
Conclusions:
- Patients needing PMV and RRT have a very poor prognosis.
- Renal insufficiency not requiring RRT had better hospital outcomes but still poor long-term survival.
- This highlights the critical condition of patients with combined respiratory and renal failure.