Yoğun bakıma kabul edilen, mekanik ventilasyon altındaki kritik hastalarda ölçülen Renal Rezistif İndeks (RRI): Doku perfüzyonunun bir göstergesi midir?

Öz

Doku hipoperfüzyonunun izlenmesi, organ disfonksiyonunun erken tanınmasını ve klinik sonuçları iyileştirir. Bu çalışma, yoğun bakım ünitesine kabul edilen ve mekanik ventilasyon uygulanan kritik hastalarda renal rezistif indeks (RRI) ile doku hipoperfüzyon göstergeleri arasındaki ilişkiyi değerlendirmeyi amaçlamıştır.1 Ekim ile 31 Mart 2023 tarihleri arasında üçüncü basamak bir hastanenin 51 yataklı YBÜ’sünde prospektif gözlemsel bir çalışma yürütülmüştür. RRI’nin doku hipoperfüzyon göstergeleri ile korelasyonu ve şok ile 28 günlük yoğun bakım mortalitesi ile ilişkisi analiz edilmiştir.Çalışma döneminde YBÜ’ye kabul edilen 575 hastanın 128’i çalışmaya dahil edilmiştir. Tüm kohort değerlendirildiğinde, RRI, P(cv–a) CO₂ (r = 0,476, p <0,001), P(cv–a) CO₂/C(a–cv) O₂ (r = 0,687, p <0,001) ve laktat (r = 0,389, p <0,001) ile pozitif korelasyon göstermiştir.Çok değişkenli analizde, RRI >0,7 (OR: 5,95; %95 GA: 2,09–16,96; p<0,001) ve laktat ≥2 mmol (OR: 3,50; %95 GA: 1,39–8,82; p=0,008) şok ile bağımsız olarak ilişkili bulunmuştur. Çok değişkenli analizde yalnızca RRI >0,7 mortalite ile bağımsız olarak ilişkili bulunmuştur (OR: 7,42; %95 GA: 2,66–20,69; p<0,001).RRI + laktat kombinasyonu en yüksek AUC değerini sağlamıştır (0,743; %95 GA: 0,655–0,831). Bunu RRI + P(cv–a) CO₂/C(a–cv) O₂ (AUC: 0,685; %95 GA: 0,591–0,779) izlemiştir. RRI, sistemik dolaşım bozuklukları ve doku perfüzyonu hakkında ek bilgiler sağlayabilir.RRI ve laktat düzeyleri şok ile bağımsız olarak ilişkili olabilirken, RRI ayrıca 28 günlük yoğun bakım mortalitesi ile bağımsız olarak da ilişkili bulunabilir.

Anahtar Kelimeler

• Renal rezistif indeks
• doku perfüzyonu
• mekanik ventilasyon
• yoğun bakım
• şok
• Doppler ultrasonografi

Destekleyen Kurum

Bu çalışma için herhangi bir finansal destek alınmamıştır.

Proje Numarası

None

Etik Beyan

Bu çalışma için etik kurul onayı Bursa Şehir Hastanesi Klinik Araştırmalar Etik Kurulu’ndan alınmıştır (Onay Tarihi: 13.09.2023; Karar No: 2023-15/4). Çalışma Helsinki Deklarasyonu’na uygun olarak yürütülmüştür.

Teşekkür

Yoktur.

Renal Resistive Index (RRI) Measured in Critically Ill Patients on Mechanical Ventilation Admitted to Intensive Care: Is It a Marker of Tissue Perfusion?

Öz

Monitoring tissue hypoperfusion improves early recognition of organ dysfunction and clinical outcome. This study aimed to evaluate the association between RRI and tissue hypoperfusion indices in critically ill patients on mechanical ventilation admitted to the intensive care unit (ICU). A prospective observational study was conducted between 1 October and 31 March 2023 in the 51-bed ICU of a tertiary hospital. The correlation of renal resistive index (RRI) with tissue hypoperfusion indices and its association with shock and 28-day ICU mortality was analysed. Of the 575 patients who were admitted to the ICU during the study period, 128 were included in the study. When the entire cohort was evaluated, RRI showed positive correlations with P(cv–a) CO2 (r=0.476, p <0.001),P(cv–a) CO2/C(a–cv) O2 (r=0.687, p<0.001), and lactate (r=0.389, p <0.001). In the multivariate analysis, RRI >0.7(OR: 5.95; 95% CI: 2.09–16.96; p<0.001) and lactate ≥2 mmol (OR:3.50; 95% CI:1.39–8.82; p=0.008 were independently associated with shock. In the multivariable analysis, only RRI >0.7 was independently associated with 28-day ICU mortality (OR: 7.42; 95% CI: 2.66–20.69; p<0.001).The combination of RRI + lactate yielded the highest AUC (0.743; 95% CI:0.655–0.831), followed by RRI + P(cv–a) CO2/C(a–cv) O2 (AUC:0.685; 95% CI:0.591–0.779). RRI may provide additional information regarding systemic circulatory disturbances and tissue perfusion. RRI and lactate levels may be independently associated with shock, while RRI may also be independently associated with 28-day ICU mortality.

Anahtar Kelimeler

• renal resistive index
• tissue perfusion
• mechanical ventilation
• intensive care
• shock
• doppler ultrasound

Destekleyen Kurum

No financial support was received.

Proje Numarası

None

Etik Beyan

Ethical approval for this study was obtained from the Bursa City Hospital Clinical Research Ethics Committee (Approval Date: September 13, 2023; Decision No: 2023-15/4). The study was conducted in accordance with the Declaration of Helsinki.

Teşekkür

None

Kaynakça

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