心停止後の腎臓損傷における血圧と酸素の標的
Sebastian Buhl Rasmussen1, Karoline Korsholm Jeppesen2, Jesper Kjaergaard3,4
1Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark.
Circulation
|October 4, 2023
まとめ
心停止後の平均低血圧とリベラルな酸素値は,軽度の急性腎臓損傷 (AKI) のリスクを高めます. この組み合わせは,重度のAKIや,再蘇生した患者の長期的な腎機能に影響を及ぼさなかった.
科学分野:
- クリティカル ケア 医療
- 腎臓科
- 心臓病科
背景:
- 急性腎臓損傷 (AKI) は,病院外心停止 (OHCA) の後の頻繁な合併症である.
- AKIを予防するための血圧と酸素の最適な治療目標は不明です.
研究 の 目的:
- OHCA後に異なる平均動脈血圧 (MAP) と動脈酸素 (PaO2) 目標値がAKI発症に与える影響を調査する.
- MAPとPaO2の特定の組み合わせが AKIのリスクと重症性に影響するかどうかを判断する.
主な方法:
- 789人の昏睡状態の成人OHCA生存者を対象としたランダム化2x2因子試験のサブ研究.
- 患者は63mmHgまたは77mmHgのMAPターゲットと9〜10kPaまたは13〜14kPaのPaO2ターゲットに割り当てられました.
- AKIは,少なくとも48時間生存した患者のKDIGO分類を用いて評価された (N=759).
主要な成果:
- 低MAP目標値 (63 mmHg) とリベラル酸素目標値 (PaO2 13−14 kPa) は,軽度のAKI (KDIGOステージ1) のリスクを有意に増加させた.
- このグループにおけるAKIの調整された確率比は1. 87 (95%CI,1. 21 - 2. 89) であった.
- 重度のAKI段階や腎臓の他のアウトカムにおいて,グループ間で有意な差異は観察されなかった.
結論:
- OHCA後の低MAPとリベラル酸素目標の組み合わせは,軽度のAKIのより高い発生率と関連しています.
- これらの特定の標的は,より重度の腎臓損傷や長期的な腎臓機能不全を引き起こさなかった.
- OHCAの生存者における最適の血動力学と酸素化の戦略をさらに研究すればよい.
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