CHEST Guidelines-Severe-Intraabdominal-Hypertension-in-Critically-I

Severe-Intraabdominal-Hypertension-in-Critically-I

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In critically ill COVID-19 patients, intraabdominal hypertension (IAH) commonly accompanies acute kidney injury (AKI) and is linked to higher mortality, especially when renal replacement therapy (RRT) is needed. A study conducted at the University Hospital of Reims screened adult patients with COVID-19-induced acute respiratory distress syndrome, requiring mechanical ventilation, who developed stage 3 AKI. It aimed to assess the occurrence of IAH at the onset of AKI and its relation to fluid load and positive end-expiratory pressure (PEEP) changes. <br /><br />The study involved 91 patients, with 64 requiring mechanical ventilation. Among these, 20 developed stage 3 AKI, with a median age of 69 years and predominantly male subjects (88.2%). All AKI patients demonstrated IAH, with 64.7% experiencing severe IAH. This severe IAH did not significantly correlate with increased RRT requirement and mortality, possibly due to the small sample size. However, the use of high PEEP levels and high fluid balance were noted risk factors for elevated intraabdominal pressures. <br /><br />The local protocol advised reducing fluid load and PEEP levels, which decreased intraabdominal pressure significantly and increased daily urine output within five days. The study highlighted the need for careful fluid and respiratory management to prevent IAH, suggesting that high PEEP without pulmonary compliance benefits can contribute to worse outcomes in kidney function. <br /><br />This research urges for prospective studies on fluid and ventilatory strategies in COVID-19 patients to optimize outcomes, underscoring the critical assessment of IAH in managing AKI. The study emphasizes the need for awareness among clinicians regarding IAH's impact on kidney function in COVID-19 and the potential benefits of its management.

Keywords

COVID-19

intraabdominal hypertension

acute kidney injury

renal replacement therapy

mechanical ventilation

positive end-expiratory pressure

fluid management

respiratory management

kidney function

clinical awareness