Dados do Trabalho

Título

Effects of Rich Bicarbonate Affluent and CO2 Removal in Renal Replacement Therapy for Acute Kidney Injury with Ultra-Protective Ventilation: A Randomized Animal Experimental Trial

Objetivo

To evaluate two pH management strategies in acute kidney injury (AKI) during ultra-protective ventilation in an experimental model.

Métodos

We conducted an experiment on a pig model of severe AKI and hypercapnia. We compared two renal replacement therapy (RRT) strategies: a bicarbonate-rich concentration (60 mEq/L) (RRT-high) versus a high bicarbonate (40 mEq/L) combined with extracorporeal CO2 removal (RRT+ECCO2-R). We assessed the time to initiate vasopressors as our primary outcome, and the evolution of hemodynamic, respiratory, and metabolic variables over 12 hours. Results are presented as hazard ratios(HR) for time-to-event variables and medians [25th/75th percentiles], with comparisons made in a mixed linear model.

Resultados

Six animals were randomized to each group. The time to initiation of vasopressors was comparable between groups (HR=0.79, 95%CI 0.22-2.8, p-value=0.71). At 12 hours, pH control (7.28 [7.22;7.33] vs. 7.24 [7.20;7.32], p=0,44) were similar between the groups. The PaCO2 was lower in the RRT+ECCO2R group (55 [45;80] vs. 60 [50;85], p=0.03). Additionally, bicarbonate levels were lower in the RRT+ECCO2R group (25.3 [23.5; 29.6] vs. 28.9 [25.0;33.9], p < 0.001. Both plateau and driving pressures were also reduced in the graphical analysis of the RRT + ECCO2R group.

Conclusão

A bicarbonate-rich RRT strategy is as effective in pH management of severe AKI with hypercapnia as the combination of RRT+ECCO2R. Additional clinical studies are warranted to address whether ECCO2R is needed in place of a less costly strategy of bicarbonate-rich affluent concentrations during KRT in this context.