Renal protection and management during extracorporeal membrane oxygenation
Cardiopulmonary Bypass: Advances in Extracorporeal Life Support, Elsevier, ss.949-964, 2022
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2022
- Doi Numarası: 10.1016/b978-0-443-18918-0.00060-7
- Yayınevi: Elsevier
- Sayfa Sayıları: ss.949-964
- Anahtar Kelimeler: Acute kidney injury, dialysis, ECMO, fluid overload, GFR, hypernatremia, hyponatremia, kidney replacement therapy, renal failure, tissue edema, uremia, urine output
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
In recent years, the use of extracorporeal membrane oxygenation (ECMO) in intensive care units for circulatory and/or respiratory support due to primary heart and/or lung failure has gained prominence, and its life-saving effectiveness has been demonstrated. Moreover, its use has spread in critically ill noncardiac patients due to pandemics worldwide, poisoning, trauma, etc. Approximately 80% of patients undergoing ECMO in intensive care may develop acute kidney injury (AKI), and at least half of them need kidney replacement therapy (KRT). On the other hand, ECMO-related AKI may develop for a number of reasons, such as ischemia-reperfusion injury, oxidative stress, inflammation, and changes in nitric oxide physiology. Fluid overload, in particular, is associated with increased mortality, and resolving fluid overload and improving fluid balance enhance organ function, particularly lung function, reducing the time spent on ECMO. For critically ill noncardiac patients on ECMO who do not respond to diuretics and fluid restriction, continuous KRT is the preferred method. Administration of KRT can reduce the renal metabolic requirement and inflammatory response as well as correct the neurohormonal pathway degradation caused by fluid overload. Further, cessation of dialysis is the last and most important step of KRT.