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Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study

The evaluation and management of fluid balance are key challenges when caring for critically ill patients requiring renal replacement therapy. The aim of this study was to assess the ability of clinical judgment and other variables to predict the occurrence of hypotension during intermittent hemodia...

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Autores principales: da Hora Passos, Rogerio, Caldas, Juliana Ribeiro, Ramos, Joao Gabriel Rosa, dos Santos Galvão de Melo, Erica Batista, Silveira, Marcelo Augusto Duarte, Batista, Paulo Benigno Pena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655072/
https://www.ncbi.nlm.nih.gov/pubmed/34880359
http://dx.doi.org/10.1038/s41598-021-03110-4
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author da Hora Passos, Rogerio
Caldas, Juliana Ribeiro
Ramos, Joao Gabriel Rosa
dos Santos Galvão de Melo, Erica Batista
Silveira, Marcelo Augusto Duarte
Batista, Paulo Benigno Pena
author_facet da Hora Passos, Rogerio
Caldas, Juliana Ribeiro
Ramos, Joao Gabriel Rosa
dos Santos Galvão de Melo, Erica Batista
Silveira, Marcelo Augusto Duarte
Batista, Paulo Benigno Pena
author_sort da Hora Passos, Rogerio
collection PubMed
description The evaluation and management of fluid balance are key challenges when caring for critically ill patients requiring renal replacement therapy. The aim of this study was to assess the ability of clinical judgment and other variables to predict the occurrence of hypotension during intermittent hemodialysis (IHD) in critically ill patients. This was a prospective, observational, single-center study involving critically ill patients undergoing IHD. The clinical judgment of hypervolemia was determined by the managing nephrologists and critical care physicians in charge of the patients on the basis of the clinical data used to calculate the ultrafiltration volume and rate for each dialysis treatment. Seventy-nine (31.9%) patients presented with hypotension during IHD. Patients were perceived as being hypervolemic in 109 (43.9%) of the cases by nephrologists and in 107 (43.1%) by intensivists. The agreement between nephrologists and intensivists was weak (kappa = 0.561). Receiver operating characteristic curve analysis yielded an AUC of 0.81 (95% CI 0.75 to 0.84; P < 0.0001), and a cutoff value of 70 mm for the vascular pedicle width (VPW) had the highest accuracy for the prediction of the absence of hypotension. The clinical judgment of hypervolemia did not predict hypotension during IHD. The high predictive ability of the VPW may assist clinicians with critical thinking.
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spelling pubmed-86550722021-12-13 Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study da Hora Passos, Rogerio Caldas, Juliana Ribeiro Ramos, Joao Gabriel Rosa dos Santos Galvão de Melo, Erica Batista Silveira, Marcelo Augusto Duarte Batista, Paulo Benigno Pena Sci Rep Article The evaluation and management of fluid balance are key challenges when caring for critically ill patients requiring renal replacement therapy. The aim of this study was to assess the ability of clinical judgment and other variables to predict the occurrence of hypotension during intermittent hemodialysis (IHD) in critically ill patients. This was a prospective, observational, single-center study involving critically ill patients undergoing IHD. The clinical judgment of hypervolemia was determined by the managing nephrologists and critical care physicians in charge of the patients on the basis of the clinical data used to calculate the ultrafiltration volume and rate for each dialysis treatment. Seventy-nine (31.9%) patients presented with hypotension during IHD. Patients were perceived as being hypervolemic in 109 (43.9%) of the cases by nephrologists and in 107 (43.1%) by intensivists. The agreement between nephrologists and intensivists was weak (kappa = 0.561). Receiver operating characteristic curve analysis yielded an AUC of 0.81 (95% CI 0.75 to 0.84; P < 0.0001), and a cutoff value of 70 mm for the vascular pedicle width (VPW) had the highest accuracy for the prediction of the absence of hypotension. The clinical judgment of hypervolemia did not predict hypotension during IHD. The high predictive ability of the VPW may assist clinicians with critical thinking. Nature Publishing Group UK 2021-12-08 /pmc/articles/PMC8655072/ /pubmed/34880359 http://dx.doi.org/10.1038/s41598-021-03110-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
da Hora Passos, Rogerio
Caldas, Juliana Ribeiro
Ramos, Joao Gabriel Rosa
dos Santos Galvão de Melo, Erica Batista
Silveira, Marcelo Augusto Duarte
Batista, Paulo Benigno Pena
Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study
title Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study
title_full Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study
title_fullStr Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study
title_full_unstemmed Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study
title_short Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study
title_sort prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655072/
https://www.ncbi.nlm.nih.gov/pubmed/34880359
http://dx.doi.org/10.1038/s41598-021-03110-4
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