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Published on: February 14, 2022
A Protective Kidney-Lung Approach to Improve Outcomes in Mechanically Ventilated Patients
Faeq Husain-Syed1, Horst-Walter Birk, Werner Seeger
1Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Campus Giessen, Giessen, Germany.
Abstract:
There is increasing evidence that deleterious interactions between the lung and the kidney may be partly responsible for the multiorgan failure and high mortality seen in patients with acute respiratory distress syndrome. Lung protective strategies can reduce many of the adverse mechanistic and biological effects of mechanical ventilation. However, the key modifiable mediators are yet to be defined for the titration of balance between protective ventilation settings and distant organ function. Disparate but complementary mechanisms that may be involved in acute lung-kidney interactions will be discussed. A kidney-lung protective strategy in patients on mechanical ventilation is a potential approach that should be exploited to improve outcomes in critically ill patients. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=448471.
Insights
Interactions between the lung and kidney contribute to mortality in acute respiratory distress syndrome (ARDS). A kidney-lung protective strategy during mechanical ventilation may improve outcomes for critically ill patients.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Nephrology
Background:
- Acute respiratory distress syndrome (ARDS) is associated with high mortality, often due to multiorgan failure.
- Deleterious lung-kidney interactions are increasingly implicated in ARDS pathophysiology.
- Mechanical ventilation, while necessary, can exacerbate these interactions.
Purpose of the Study:
- To discuss the mechanisms underlying acute lung-kidney interactions in ARDS.
- To explore the concept of a kidney-lung protective strategy.
- To identify modifiable mediators for balancing ventilation settings and distant organ function.
Main Methods:
- Review of existing evidence on lung-kidney crosstalk in ARDS.
- Discussion of disparate but complementary mechanisms involved.
- Conceptualization of a protective strategy.
Main Results:
- Evidence suggests lung-kidney interactions contribute to ARDS mortality.
- Lung protective strategies mitigate some adverse effects of mechanical ventilation.
- Key modifiable mediators for optimizing ventilation and organ protection require further definition.
Conclusions:
- Lung-kidney interactions play a significant role in ARDS.
- A kidney-lung protective approach during mechanical ventilation is a promising strategy.
- Further research is needed to define optimal protective parameters for critically ill patients.
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