| Abstrakt: |
Objective: To address the impact of continuous venovenous hemodiafiltration (CVVHDF) on microcirculation of patients with acute kidney injury. Methods: Prospective observational pilot study was conducted in a forty bed, open clinical-surgical, ICU of a private, tertiary care, hospital in São Paulo, Brazil. Microcirculation was assessed using near-infrared spectroscopy (NIRS) (InSpectra StO2 Tissue Oxygenation Monitor model 650, Hutchinson, MN, USA) with a 15-mm probe over the thenar eminence. Vascular occlusion test (VOT) were performed by inflation of a sphygmomanometer cuff to 30 mmHg above the systolic arterial pressure on the forearm of the NIRS during 3 minutes. Primary endpoint was the assessment of NIRSderived parameters, immediately before, one, four, and 24 hours after the initiation of CVVHDF. Results: Nine patients were included in this study over a period of two months. Median (IQR) age was 66 (61 - 76) years and SAPS III score was 60 (51-63). Baseline median (IQR) tissue oxygen saturation (StO2), maximum StO2, descending slope, ascending slope and recovery time were, respectively, 83 (81-89) %, 94 (87-95) %, 8.3 (4.4-10.4) %/min, 1.6 (1.2-3.1) %/sec and 31.0 (29.5-48.5) sec. Only minimum StO2 during VOT was different over the time, with a decrease from 64 (49-67) % at baseline to 52 (43-59) % after 24 hours of CVVHDF initiation (p=0.023). Conclusion: Minimum StO2 measured during the VOT was the only NIRS-derived parameter affected during the first 24 hours of CVVHDF. [ABSTRACT FROM AUTHOR] |
