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Hemodynamically stable oliguric patients usually do not respond to fluid challenge
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 rec...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Associação de Medicina Intensiva Brasileira - AMIB
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853676/ https://www.ncbi.nlm.nih.gov/pubmed/33470358 http://dx.doi.org/10.5935/0103-507X.20200094 |
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author | Felice, Vinicius Brenner Lisboa, Thiago Costa de Souza, Lucas Vieira Sell, Luana Canevese Friedman, Gilberto |
author_facet | Felice, Vinicius Brenner Lisboa, Thiago Costa de Souza, Lucas Vieira Sell, Luana Canevese Friedman, Gilberto |
author_sort | Felice, Vinicius Brenner |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7853676 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Associação de Medicina Intensiva Brasileira - AMIB |
record_format | MEDLINE/PubMed |
spelling | pubmed-78536762021-02-04 Hemodynamically stable oliguric patients usually do not respond to fluid challenge Felice, Vinicius Brenner Lisboa, Thiago Costa de Souza, Lucas Vieira Sell, Luana Canevese Friedman, Gilberto Rev Bras Ter Intensiva Original Article 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. Associação de Medicina Intensiva Brasileira - AMIB 2020 /pmc/articles/PMC7853676/ /pubmed/33470358 http://dx.doi.org/10.5935/0103-507X.20200094 Text en http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Felice, Vinicius Brenner Lisboa, Thiago Costa de Souza, Lucas Vieira Sell, Luana Canevese Friedman, Gilberto Hemodynamically stable oliguric patients usually do not respond to fluid challenge |
title | Hemodynamically stable oliguric patients usually do not respond to fluid challenge |
title_full | Hemodynamically stable oliguric patients usually do not respond to fluid challenge |
title_fullStr | Hemodynamically stable oliguric patients usually do not respond to fluid challenge |
title_full_unstemmed | Hemodynamically stable oliguric patients usually do not respond to fluid challenge |
title_short | Hemodynamically stable oliguric patients usually do not respond to fluid challenge |
title_sort | hemodynamically stable oliguric patients usually do not respond to fluid challenge |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853676/ https://www.ncbi.nlm.nih.gov/pubmed/33470358 http://dx.doi.org/10.5935/0103-507X.20200094 |
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