Continuous bladder urinary oxygen tension as a new tool to monitor medullary oxygenation in the critically ill.

Autor: Hu RT; Department of Anaesthesia, Austin Health, Heidelberg, VIC, Australia. Raymond.hu@austin.org.au.; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia. Raymond.hu@austin.org.au., Lankadeva YR; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia.; Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia., Yanase F; Department of Intensive Care, Austin Hospital, Heidelberg, Australia., Osawa EA; Cardiology Intensive Care Unit, DF Star Hospital, Brasília, Brazil.; D'Or Institute for Research and Education (IDOR), DF Star Hospital, Brasília, Brazil., Evans RG; Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.; Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, VIC, Australia., Bellomo R; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia.; Department of Intensive Care, Austin Hospital, Heidelberg, Australia.; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.; Department of Intensive Care, Royal Melbourne Hospital, Parkville, Australia.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2022 Dec 16; Vol. 26 (1), pp. 389. Date of Electronic Publication: 2022 Dec 16.
DOI: 10.1186/s13054-022-04230-7
Abstrakt: Acute kidney injury (AKI) is common in the critically ill. Inadequate renal medullary tissue oxygenation has been linked to its pathogenesis. Moreover, renal medullary tissue hypoxia can be detected before biochemical evidence of AKI in large mammalian models of critical illness. This justifies medullary hypoxia as a pathophysiological biomarker for early detection of impending AKI, thereby providing an opportunity to avert its evolution. Evidence from both animal and human studies supports the view that non-invasively measured bladder urinary oxygen tension (PuO 2 ) can provide a reliable estimate of renal medullary tissue oxygen tension (tPO 2 ), which can only be measured invasively. Furthermore, therapies that modify medullary tPO 2 produce corresponding changes in bladder PuO 2 . Clinical studies have shown that bladder PuO 2 correlates with cardiac output, and that it increases in response to elevated cardiopulmonary bypass (CPB) flow and mean arterial pressure. Clinical observational studies in patients undergoing cardiac surgery involving CPB have shown that bladder PuO 2 has prognostic value for subsequent AKI. Thus, continuous bladder PuO 2 holds promise as a new clinical tool for monitoring the adequacy of renal medullary oxygenation, with its implications for the recognition and prevention of medullary hypoxia and thus AKI.
(© 2022. Crown.)
Databáze: MEDLINE
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