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Fluid therapy and acute kidney injury in cardiogenic shock after cardiac arrest
Resuscitation, 07/05/2012
Clinical Article
Adler C et al. – The presented data suggest that volume therapy guided by volumetric (ELWI, GEDI) and arterial waveform derived variables (PPV, SVV) can reduce the incidence of acute kidney injury (AKI) in patients with cardiogenic shock after cardiac arrest treated with mild therapeutic hypothermia.
Methods- Fluid therapy and the incidence of acute kidney injury (AKI) was retrospectively reviewed in 51 patients with cardiogenic shock after cardiac arrest comparing patients with and without hemodynamic (PPV, SVV) and volumetric (ELWI, GEDI) monitoring.
- There was no significant difference in baseline or cardiac arrest characteristics between hemodynamic monitored patients and conventional monitored patients.
- 28 patients were monitored by standard monitoring, in 23 patients monitoring was complemented by a PICCO System.
- In the first 24h of treatment the total amount of fluid was significantly higher in patients under PICCO monitoring compared to conventional monitoring (4375±1285ml vs. 5449±1438ml, p=0.007).
- This was associated with a significant reduction in the incidence of AKI (RIFLE ‘I’/‘F’: PICCO–group: 1 (4.3%) vs. conventional group 8 (28.6%), p=0.03).