News

Thank you for visiting Nature.com. The browser version you are using has limited CSS support. For the best experience, we recommend that you use an updated browser (or disable Compatibility Mode in Internet Explorer). In the meantime, to ensure continued support, we will render the site without styles and JavaScript.
We examined the value of bedside ultrasound dynamic monitoring of inferior vena cava diameter (IVCD) and sniffing collapse (inferior vena cava collapse index [IVCCI]) in the management of dehydration in patients on combined renal replacement therapy (CRRT). Heart failure and acute heart failure. A total of 90 patients with renal and acute heart failure were selected who received CRRT in the intensive care unit (ICU) from January 2019 to June 2021. According to various methods for assessing blood volume, patients were randomly divided into ultrasound group, experience group and a control group. We compared serum creatinine, potassium, and brain N-terminal natriuretic peptide (NT-proBNP) precursor levels, time to improvement in heart failure symptoms, time to CRRT, ventilator use, length of ICU stay, vasopressor use, and group morbidity. unwanted events. There were no significant differences in serum creatinine, potassium, and NT-proBNP levels in pairwise comparisons among groups before and after CRRT (P > 0.05). There were no significant differences in serum creatinine, potassium, and NT-proBNP levels in pairwise comparisons among groups before and after CRRT (P > 0.05). Не было никаких существенных различий в уровнях креатинина в сыворотке, калия и NT-proBNP при попарных сравнениях между группами до и после ПЗПТ (P > 0,05). There were no significant differences in serum creatinine, potassium, and NT-proBNP levels in pairwise comparisons between groups before and after CRRT (P > 0.05). CRRT前后各组血清肌酐、血钾、NT-proBNP水平比较差异无统计学意义（P>0.05）。 CRRT前后各组血清肌酐、血钾、NT-proBNP水平比较差异无统计学意义（P>0.05）。 Не было существенной разницы в уровнях сывороточного креатинина, сывороточного калия и NT-proBNP между группами до и после ПЗПТ (P>0,05). There was no significant difference in serum creatinine, serum potassium, and NT-proBNP levels between pre- and post-CRRT groups (P>0.05). Time to improvement in heart failure symptoms, CRRT time, and ICU stay were lower in the ultrasound and experience groups than in the control group; the differences were statistically significant (P < 0.05). the differences were statistically significant (P < 0.05). различия были статистически значимыми (P < 0,05). the differences were statistically significant (P < 0.05).差异有统计学意义（P < 0.05）。差异有统计学意义（P < 0.05）。 Разница была статистически значимой (P <0,05). The difference was statistically significant (P<0.05). Ventilator use duration was lower in the ultrasound and experience groups compared with the control group, with a statistically significant difference between the ultrasound and control groups (P < 0.05). Ventilator use duration was lower in the ultrasound and experience groups compared with the control group, with a statistically significant difference between the ultrasound and control groups (P < 0.05). Продолжительность использования ИВЛ была ниже в группах УЗИ и опыта по сравнению с контрольной группой со статистически значимой разницей между группами УЗИ и контроля (P <0,05). The duration of ventilator use was lower in the ultrasound and experience groups compared with the control group, with a statistically significant difference between the ultrasound and control groups (P<0.05).超声组和体验组呼吸机使用时间低于对照组，超声组与对照组比较差异有统计学意义（P < 0.05）。 P < 0.05）。 Время использования ИВЛ в группе УЗИ и опытной группе было меньше, чем в контрольной группе, а разница между группой УЗИ и контрольной группой была статистически значимой (P < 0,05). The time of ventilator use in the US group and the experimental group was shorter than in the control group, and the difference between the US group and the control group was statistically significant (P < 0.05). The time of application of vasopressors in both the ultrasound group and the control group was less than in the experimental group; the difference was statistically significant (P < 0.05). the difference was statistically significant (P < 0.05). Разница была статистически значимой (P <0,05). The difference was statistically significant (P<0.05).差异有统计学意义（P < 0.05）。差异有统计学意义（P < 0.05）。 Разница была статистически значимой (P <0,05). The difference was statistically significant (P<0.05). The ultrasound group had a lower incidence of adverse events compared to the experimental and control groups; the difference was statistically significant (P < 0.05). the difference was statistically significant (P < 0.05). Разница была статистически значимой (P <0,05). The difference was statistically significant (P<0.05).差异有统计学意义（P < 0.05）。差异有统计学意义（P < 0.05）。 Разница была статистически значимой (P <0,05). The difference was statistically significant (P<0.05). Ultrasound dynamic monitoring of EFA and nasal collapse can accurately assess the state of blood volume and provide recommendations for correcting dehydration in CRRT and rapidly relieving symptoms of heart failure in patients with renal and acute heart failure.
Renal failure associated with acute heart failure is a clinically critical disease characterized by rapid disease progression, prolonged hospital stay and high mortality, which seriously threatens patient safety. In clinical practice, the main treatment strategy is the relief of symptoms of heart failure, including cardiotonic, diuretic and vasodilators. However, due to renal insufficiency, the accumulated metabolites and blood volume in these patients cannot be excreted through the kidneys. Hypertension and congestion often respond poorly to conventional diuretics and vasodilators alone, while continuous renal replacement therapy (CRRT) can repair kidney damage through cardiopulmonary blood clearance, continuous removal of metabolites and excess blood volume from the body, thereby reducing preoperative and postoperative cardiovascular failure. exercise that effectively improves the symptoms and general condition of patients with heart failure3.
However, the clinical use of CRRT often causes various complications, one of the main of which is arterial hypotension4,5. Studies have shown that the degree of blood volume reduction is an important cause of changes in blood pressure during CRRT. Excessive and rapid dehydration exceeds interstitial fluid return resulting in effective hypovolemia and hypotension6. Properly assessing a patient’s blood volume status during CRRT and designing an optimal dehydration regimen is a challenge faced by clinicians.
In recent years, ultrasound monitoring of inferior vena cava (SVC) diameter and its variability (NSAID and odor collapse, inferior vena cava collapse index [IVVC]) has been used because of its intuitive, accurate, non-invasive, and reproducible advantages. Previous studies have suggested using the IVCD as a benchmark for assessing blood volume status in patients7,8,9 but there are fewer reports of the use of CRRT in patients with renal failure complicated by acute heart failure. Thus, we aimed to investigate the clinical application of bedside dynamic monitoring of NSAIDs and NSAIDs to correct dehydration during CRRT in patients with renal failure complicated by acute heart failure.
This study adopted a prospective randomized controlled design and was approved by the Biomedical Research Ethics Committee of Nanchang University Second Affiliated Hospital. The study was conducted in accordance with relevant guidelines and regulations. All patients were informed of the potential benefits and risks. All patients received written informed consent.
We selected 90 patients with renal insufficiency combined with acute heart failure requiring CRRT who were admitted to the intensive care unit (ICU) of our hospital from January 2019 to June 2021.Mean age of participants was 68.23±11. 41 years old, 28 women and 62 men.
We included the following patients: (1) aged ≥18 years and ≤80 years; (2) agreed with CRRT; (3) in accordance with the “Preliminary guidelines for the diagnosis and treatment of acute heart failure with improved overall outcomes in Kidney disease (2019)” Diagnostic criteria for heart failure.
We excluded patients with any of the following: (1) a history of malignancy or psychiatric illness; (2) a history of congenital heart disease, hypertrophic cardiomyopathy, or pulmonary hypertension; (3) impaired clotting function during the last 3 months. visceral or gastrointestinal bleeding or contraindications to heparin anticoagulant therapy; (4) CRRT time ≤ 12 hours; (5) Ultrasound cannot detect the inferior vena cava, resulting in missing data; (6) cardiogenic shock or cardiac ejection fraction ≤ 50%.
Patients were randomly divided into three groups (ultrasound, experimental and control) using a random number table. Each group included 30 patients. There were no statistically significant differences between the three groups for gender, age, acute physiological condition, and chronic disease scale II, and participant characteristics were comparable between groups at baseline (Table 1).
To begin CRRT, doctors lay the patient on their back and expose their chest and abdomen. The area from IVCD to the xiphoid process was then measured using a 3.5 MHz convex array probe of the Mindray M7 handheld color Doppler ultrasound instrument. Multiple respiratory cycles were recorded using M-mode ultrasound at a distance of 2.0 cm from the right heart along the inferior vena cava. The maximum end-inspiratory diameter (IVCDmax) and the minimum end-expiratory diameter (IVCDmin) were measured simultaneously. IVCD is defined as IVCDmax and IVCCI is calculated using the following formula: (IVCDmax-IVCDmin)/IVCDmax×100%. All examinations were performed by a team of ultrasound specialists, consisting of physicians with ultrasound qualifications. All physicians receive the same quality control training to ensure thorough collection of ultrasound data. Based on the IVCD measured by the chief ultrasound physician as the conventional true value, the pre-experiment analysis indicated a relative error for IVCD measurements by different physicians of < 0.05 and a relative error of IVCD measurements by the same physician at different time periods of < 0.02. Based on the IVCD measured by the chief ultrasound physician as the conventional true value, the pre-experiment analysis indicated a relative error for IVCD measurements by different physicians of < 0.05 and a relative error of IVCD measurements by the same physician at different time periods of < 0.02. На основании измеренного главным врачом УЗИ МЖК как условно истинного значения, предэкспериментальный анализ показал относительную погрешность измерения МЖК разными врачами < 0,05 и относительную погрешность измерения МЖК одним и тем же врачом в разные периоды времени < 0,02. Based on the MFA measured by the head ultrasound doctor as a conditionally true value, the pre-experimental analysis showed a relative error in measuring MFA by different doctors < 0.05 and a relative error in measuring MFA by the same doctor at different time periods < 0.02.以超声主任医师测量的IVCD为常规真值，实验前分析表明不同医师IVCD测量的相对误差<0.05，同一医师不同时间段IVCD测量的相对误差< 0.02。以 超声 主任 医师 测量 的 ivcd 为 常规 ， 实验 前 分析 表明 医师 医师 医师 vvcd 测量 的 误差 误差 误差 <0.05 ， 一 医师 不同 时间 段 IVCD 测量 的 相对 <0.02。 <0.02。 Принимая за условную истинную величину МЖК, измеренную главным врачом УЗИ, предэкспериментальный анализ показал, что относительная погрешность измерения МЖК разными врачами составляет <0,05, а относительная погрешность измерения МЖК одним и тем же врачом в разные периоды времени был <0,02. Taking as a conditional true value of the MFA measured by the head ultrasound doctor, the pre-experimental analysis showed that the relative error of measuring the MFA by different doctors is <0.05, and the relative error of measuring the MFA by the same doctor in different periods of time was <0.02. The measurement time for each ultrasonic method is approximately 10 to 15 minutes. Each indicator was measured 3 times and the average value was calculated. Physicians corrected dehydration according to IVCD and IVCCI by repeating the above procedure every 4 hours until CRRT was discontinued.
Blood volume status was evaluated according to the practical guidelines of the British Society of Echocardiography10: IVCD ≤ 2.1 cm with IVCCI > 50%, defined as a low volume status; Blood volume status was evaluated according to the practical guidelines of the British Society of Echocardiography10: IVCD ≤ 2.1 cm with IVCCI > 50%, defined as a low volume status; Статус объема крови оценивался в соответствии с практическими рекомендациями Британского общества эхокардиографии10: IVCD ≤ 2,1 см с IVCCI > 50%, что определялось как низкообъемный статус; Blood volume status was assessed according to the practice recommendations of the British Society of Echocardiography10: IVCD ≤ 2.1 cm with IVCCI > 50%, which was defined as low volume status;根据英国超声心动图学会的实用指南评估血容量状态10：IVCD ≤ 2.1 cm 且IVCCI > 50%，定义为低容量状态； According to the practical guide of the United Kingdom ultrasonography society’s assessment of blood volume status10: IVCD ≤ 2.1 cm 且IVCCI > 50%, defined as low volume status; Оценка объема крови в соответствии с практическими рекомендациями Британского общества эхокардиографии10: IVCD ≤ 2,1 см и IVCCI > 50%, определяется как гиповолемический статус; Assessment of blood volume according to the practical recommendations of the British Society of Echocardiography10: IVCD ≤ 2.1 cm and IVCCI > 50%, defined as hypovolemic status; IVCD ≤ 2.1 cm with IVCCI < 50% or IVCD > 2.1 cm with IVCCI > 50%, defined as a balanced volume status; IVCD ≤ 2.1 cm with IVCCI < 50% or IVCD > 2.1 cm with IVCCI > 50%, defined as a balanced volume status; IVCD ≤ 2,1 см при IVCCI < 50% или IVCD > 2,1 см при IVCCI > 50%, что определяется как состояние сбалансированного объема; IVCD ≤ 2.1 cm with IVCCI < 50% or IVCD > 2.1 cm with IVCCI > 50%, which is defined as volume-balanced status; IVCD ≤ 2.1 cm 且IVCCI < 50% 或IVCD > 2.1 cm 且IVCCI > 50%，定义为平衡容积状态； IVCD ≤ 2.1 cm 且IVCCI < 50% or IVCD > 2.1 cm 且IVCCI > 50%, defined as balanced volume state; IVCD ≤ 2,1 см и IVCCI <50% или IVCD> 2,1 см и IVCCI> 50%, определяемые как состояние равновесного объема; IVCD ≤ 2.1 cm and IVCCI < 50% or IVCD > 2.1 cm and IVCCI > 50%, defined as a state of equilibrium volume; and IVCD > 2.1 cm with IVCCI < 50%, defined as a high volume status. and IVCD > 2.1 cm with IVCCI < 50%, defined as a high volume status. и IVCD > 2,1 см с IVCCI < 50%, что определяется как состояние большого объема. and IVCD > 2.1 cm with IVCCI < 50%, which is defined as high volume status.和IVCD > 2.1 cm 且IVCCI < 50%，定义为高容量状态。和IVCD > 2.1 cm 且IVCCI < 50%, defined as high capacity state. и IVCD > 2,1 см и IVCCI < 50%, что определяется как состояние большого объема. and IVCD > 2.1 cm and IVCCI < 50%, which is defined as a large volume condition. Daily diuresis of healthy people is 1500-2000 ml. For the convenience of calculations, the normal daily diuresis is defined as 1800 ml, with an average diuresis of 300 ml every 4 hours. Previous preliminary experiments have shown that if the volume of dehydration exceeds the normal volume of urine by 4 times during 4 hours in a state of high volume, the frequency of complications increases significantly; if it exceeds the normal volume of urine by 2 times, the time of improvement of the symptoms of heart failure and the frequency of complications have increased significantly. In conditions of volume balance, the frequency of complications increased significantly when the volume of dehydration exceeded 2 times the normal volume of urine during 4 hours, and the time to improvement of symptoms of heart failure increased significantly when the volume of dehydration was the same as the normal volume of urine. . The target volume of dehydration during 4 hours was set at the level of 1000 ml in patients with hypervolemia and 500 ml in patients with balanced blood volume. Because continued dehydration in the hypovolemic state can lead to hypotension, and hydration worsens symptoms of heart failure, clinicians adjust the 4-hour dehydration target to 0 mL for hypovolemic patients (CRRT 4-hour dehydration = 4-hour dehydration target + 4- hourly reception – 4-hour diuresis).
Physicians corrected for dehydration using a common empirical scale based on heart rate, mean arterial pressure, central venous pressure, and pulmonary rales after CRRT (Table 2).
Assessments were made every 4 hours from the start of CRRT until the patient was assisted to dismount from the device. The clinician adjusted the 4 hour dehydration target to 1000 ml, 500 ml and 0 ml and scored 8-11, 4-7 and 0-3 (NRRT at 4 hours = 4 hour target) Volume + 4 hour intake – 4- hourly urine output).
From initiation of CRRT to discontinuation of the drug, the dehydration target was constant at 100 ml/h and no volume was assessed during treatment (CRRT dehydration at 4 hours = target dehydration at 4 hours + intake at 4 hours). h) h – diuresis 4 h).
In addition to the above experimental targeted measures to correct dehydration, all three groups of patients received homogeneous treatment, including treatment of the underlying disease, anti-infective regimen, airway management, mechanical ventilation strategy, fluid volume maintenance and electrolyte balance (4.0 mmol)) /l < potassium < 5.3 mmol/l), drug therapy, colloidal liquid supplementation such as albumin (to maintain albumin levels > 3.5 g/l), and nutritional support.
All three patient groups were treated with the same blood purifier (PrismaFlex system) and the same CRRT regimen (CVVHD regimen). All patients received extracorporeal heparin for local anticoagulation and protamine neutralization. Doctors adjust the doses of heparin and protamine based on four blood clotting parameters (activated partial thromboplastin time is maintained within 1-1.5 times normal). In CPT, blood flow was maintained at 150-200 ml/min and dialysate flow was maintained at 2000 ml/h (dialysate formulation: saline 2000 ml; sterile injection volume 1000 ml; 50% glucose solution 10 ml; 10% saline , 20 ml; magnesium sulfate, 2.5 ml; 10% potassium chloride, 7.5 ml; sodium bicarbonate, 45 ml; peripheral calcium chloride, 10 ml/hour).
When the patient develops hypotension, stop dehydration immediately and administer intravenous fluids and vasopressors (including norepinephrine and dopamine) as needed to maintain the patient’s mean arterial pressure above 65 mmHg.
Serum creatinine, potassium, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured 24 hours before and after CRRT. Time to improvement in heart failure, time to CRRT, time to ventilator use, time to intensive care unit stay, time to vasopressor use, and adverse event rates (including hypotension, arrhythmias, and delirium but not malignant rhythm) were collected during hospitalization . ) data. Intensive Care Unit. The frequency of adverse events was calculated based on whether adverse events occurred in enrolled patients.
Improvement in symptoms: According to the New York Classification of Heart Function, chest tightness and dyspnea improved to grade 1, and the frequency of expectoration of pink foamy sputum decreased by 20% compared to the previous assessment (excluding patients with endotracheal intubation), symptoms were considered improved.
Improved monitoring: 20% reduction in heart rate, respiratory rate, central venous pressure, or mean arterial pressure.
Physicians perform hourly assessments, and when patients meet all three of the above criteria, their heart failure is considered to have improved.
Statistical analysis was performed using SPSS 22.0 software (IBM Corp., Armonk, NY, USA). Continuous data are expressed as mean ± standard deviation. Categorical data is described as frequencies and percentages. Differences between the two groups were assessed using Student’s t-test for continuous variables or chi-square test for categorical variables. Statistical significance was set at P < 0.05. Statistical significance was set at P < 0.05. Статистическая значимость была установлена ​​на уровне P <0,05. Statistical significance was set at P<0.05.统计学显着性设定为P < 0.05。统计学显着性设定为P < 0.05。 Статистическая значимость была установлена ​​на уровне P <0,05. Statistical significance was set at P<0.05.
Serum creatinine, potassium, and NT-proBNP levels in the three groups decreased within 24 hours of CRRT. The differences within the groups were statistically significant (P < 0.05), although there were no significant differences observed in pairwise comparisons among the three groups (P > 0.05) (Table 3). The differences within the groups were statistically significant (P < 0.05), although there were no significant differences observed in pairwise comparisons among the three groups (P > 0.05) (Table 3). Различия внутри групп были статистически значимыми (P < 0,05), хотя при попарном сравнении между тремя группами не наблюдалось существенных различий (P > 0,05) (таблица 3). Differences within groups were statistically significant (P < 0.05), although there were no significant differences between the three groups when pairwise compared (P > 0.05) (Table 3).组内差异具有统计学意义（P < 0.05），但三组之间的成对比较无显着差异（P > 0.05）（表3）。组内差异具有统计学意义（P < 0.05），但三组之间的成对比较无显着差异（P > 0.05）（表3）。 Различия внутри групп были статистически значимыми (P <0,05), но попарные сравнения между тремя группами существенно не отличались (P> 0,05) (таблица 3). Differences within groups were statistically significant (P < 0.05), but pairwise comparisons between the three groups were not significantly different (P > 0.05) (Table 3). To better visualize the volume changes, we also plotted the changes in NT-proBNP, IVCD, and IVCCI (Figures 1 and 2).
Dynamics of the mean values ​​of IVKD and IVKKI of the first CPT in the ultrasound group of 30 patients after admission to the ICU
Heart failure improvement time, CRRT time, and ICU stay were significantly lower in the ultrasound and experience group than in the control group. The differences were statistically significant (P < 0.05), whereas there were no significant differences in the above indicators between the ultrasound and experience groups (P > 0.05) (Fig. 3). The differences were statistically significant (P < 0.05), whereas there were no significant differences in the above indicators between the ultrasound and experience groups (P > 0.05) (Fig. 3). Различия были статистически значимыми (Р < 0,05), тогда как достоверных различий по вышеуказанным показателям между группами УЗИ и опыта не было (Р > 0,05) (рис. 3). The differences were statistically significant (P < 0.05), while there were no significant differences in the above parameters between the ultrasound and experience groups (P > 0.05) (Fig. 3).差异有统计学意义（P < 0.05），而超声组与体验组在上述指标上差异无统计学意义（P > 0.05）（图3）。差异有统计学意义（P < 0.05），而超声组与体验组在上述指标上差异无统计学意义（P > 0.05）（图3 Разница была статистически значимой (Р < 0,05), но достоверной разницы между группой УЗИ и группой опыта по вышеуказанным показателям не было (Р > 0,05) (рис. 3). The difference was statistically significant (P < 0.05), but there was no significant difference between the ultrasound group and the experimental group in terms of the above parameters (P > 0.05) (Fig. 3).
The duration of ALV use both in the ultrasound group and in the experimental group was lower than in the control group. The difference between the ultrasound and control groups was statistically significant (P < 0.05), whereas no significant difference was observed between the experience and control groups, or between the experience and ultrasound groups (P > 0.05). The difference between the ultrasound and control groups was statistically significant (P < 0.05), whereas no significant difference was observed between the experience and control groups, or between the experience and ultrasound groups (P > 0.05). Разница между ультразвуковой и контрольной группами была статистически значимой (P < 0,05), тогда как между опытной и контрольной группами, а также между опытной и ультразвуковой группами не наблюдалось существенной разницы (P > 0,05). The difference between the ultrasound and control groups was statistically significant (P < 0.05), while there was no significant difference between the treatment and control groups and between the treatment and ultrasound groups (P > 0.05).超声组与对照组差异有统计学意义（P < 0.05），而经验组与对照组或经验组与超声组之间差异无统计学意义（P > 0.05）。超声组 与 对照组 差异 有 意义 （p <0.05） 而 经验组 与 对照组 或 经验组 与 超声组 之间 无 统计学 意义 （p> 0.05）。。 Разница между группой УЗИ и контрольной группой была статистически значимой (P < 0,05), но не было существенной разницы между группой опыта и группой контроля или между группой опыта и группой УЗИ (P> 0,05). The difference between the ultrasound group and the control group was statistically significant (P < 0.05), but there was no significant difference between the study group and the control group or between the study group and the ultrasound group (P > 0.05).
The time of vasopressor use in the US and control groups was shorter than in the treatment group and the difference was statistically significant (P < 0.05), while there was no significant difference between the US and control groups (P > 0.05). ) (Table 4).
Adverse events occurred in 5 of 30 patients in the ultrasound group (5 with hypotension, 1 with arrhythmia), in 16 of 29 patients in the experience group (16 with hypotension, 4 with arrhythmia and 1 with delirium), and in the control group: in the group there were 16 cases out of 29 (7 cases of hypotension, 8 cases of arrhythmia, 6 cases of delirium). The incidence of adverse events in the ultrasound group was significantly lower than that in the experience and control groups, and the difference was statistically significant (P < 0.05). The incidence of adverse events in the ultrasound group was significantly lower than that in the experience and control groups, and the difference was statistically significant (P < 0.05). Частота нежелательных явлений в группе УЗИ была значительно ниже, чем в опытной и контрольной группах, и разница была статистически значимой (P < 0,05). The incidence of adverse events in the ultrasound group was significantly lower than in the experimental and control groups, and the difference was statistically significant (P < 0.05).超声组不良事件发生率明显低于体验组和对照组，差异有统计学意义（P<0.05）。 P<0.05）。 Частота нежелательных явлений в группе УЗИ была значительно ниже, чем в группе опыта и контрольной группе, и разница была статистически значимой (P<0,05). The incidence of adverse events in the ultrasound group was significantly lower than in the experimental and control groups, and the difference was statistically significant (P<0.05). Conversely, the difference between the experience and control groups was not statistically significant (P > 0.05) (Table 5). Conversely, the difference between the experience and control groups was not statistically significant (P > 0.05) (Table 5). Напротив, разница между опытной и контрольной группами не была статистически значимой (P > 0,05) (табл. 5). On the contrary, the difference between the experimental and control groups was not statistically significant (P > 0.05) (Table 5).相反，经验组和对照组之间的差异无统计学意义（P > 0.05）（表5）。相反，经验组和对照组之间的差异无统计学意义（P > 0.05）（表5）。 Напротив, разница между опытной группой и контрольной группой не была статистически значимой (P > 0,05) (таблица 5). On the contrary, the difference between the experimental group and the control group was not statistically significant (P > 0.05) (Table 5).
Renal failure in combination with acute heart failure involves complex pathophysiological processes. Metabolites and excess fluid in the body cannot be excreted by damaged kidneys. Accumulation of metabolites and body fluids can increase cardiac workload and even lead to acute heart failure11.
The interaction between kidney failure and heart failure is exacerbated, forming a vicious circle that eventually leads to a sharp deterioration in heart and kidney function, which seriously threatens patient safety12. The kidneys remove excess fluids and metabolites from the body to improve the patient’s condition13. However, the best way to achieve rapid and safe relief of heart failure symptoms remains unclear. Therefore, it is very important to correctly assess the patient’s blood volume status in order to facilitate the correction of dehydration for CRRT.
Currently, the main methods for assessing blood volume include the use of pulmonary artery catheters, pulse assessment (indicating continuous cardiac output), transesophageal echocardiography, and bioimpedance14,15,16,17. These methods have advantages, but also many limitations. Many clinicians still prefer to use general empirical methods to assess a patient’s blood volume, such as assessing a patient’s dry weight, assessing the presence of pulmonary rales or edema in the lower extremities and face, and assessing changes in vital signs. Although these methods are simple and easy to implement, their reliability is low and they cannot meet the requirements of fast, dynamic, accurate and non-invasive clinical evaluation.
This study used ultrasound and empirical methods to measure blood volume in patients in the ultrasound and experience groups, and compared the results with a control group. We found that serum creatinine, potassium, and NT-proBNP levels decreased in the three groups during 24 hours of CRRT, and there was no significant difference between the three groups, indicating that different blood volume assessment methods did not affect serum efficiency. creatinine and potassium clearance during initial treatment. No significant effect on NT-proBNP levels was observed.
We also found that time to improvement in heart failure, CRRT time, and ICU stay were significantly shorter in the ultrasound and experimental groups than in the control group. Compared with the control group, the time of using the ventilator in the ultrasound group was significantly reduced, and the difference was statistically significant. These results suggest that the ultrasound and treatment group experienced faster improvement in HF symptoms, shorter CRRT time, and ICU stay compared to the control group without fluid volume assessment.
Our study suggests that timely assessment of ambulatory fluid volume during CRRT is of great clinical value in managing dehydration in patients with renal insufficiency and acute heart failure.
When comparing the use of vasopressors and the incidence of adverse events (eg, hypotension, arrhythmia, delirium), we found that the duration of vasopressor use was significantly shorter in the US and control groups than in the treatment group, and the incidence of adverse events in the US group was significantly lower ( hypotension, arrhythmia, delirium) is significantly lower than in the experimental and control groups.
We have considered several reasons for these results. First, empirical methods have some value in evaluating high volume patients, such as rapid improvement in heart failure symptoms, CRRT time, and ICU stay, while their accuracy is questionable in volume deficient patients. have a reflex increase in heart rate and blood pressure, which can manifest itself as a pseudo-hypervolemic state against the background of CRRT, leading to rapid dehydration, which increases the frequency of hypotension and the duration of vasopressor use. Second, patients in the control group dehydrated slowly and evenly. Although the use of vasopressors is shorter, symptoms of heart failure resolve slowly, CRRT time is significantly increased, ICU stay is prolonged, and the incidence of adverse events such as arrhythmia and delirium is increased. Third, patients in the three groups remained on the ventilator significantly longer than the symptoms of heart failure improved, possibly due to improved oxygen levels in patients after the ventilator. In addition, although the patient’s blood volume was still congested, the symptoms of heart failure improved significantly. If the ventilator is stopped, symptoms of heart failure may return. Therefore, the duration of mechanical ventilation should be increased to ensure that the patient’s symptoms of heart failure do not recur.
In contrast, heart failure symptoms improved rapidly in the ultrasound group, with significantly shorter CRRT time, ICU stay, and ventilator use. More importantly, the incidence of CRRT-associated hypotension, duration of vasopressor use, and adverse events were significantly reduced.
The main limitation of our study is that it was a single center study with a small sample size. Therefore, a multicentre prospective study with a large sample size is needed to confirm our findings and provide clinicians with a better basis.
In conclusion, due to the rapid progression of renal failure in combination with acute heart failure, blood volume estimation should be more intuitive and accurate. Ultrasound dynamic monitoring of NSAIDs and NSAIDs can provide accurate recommendations for correcting CRRT dehydration in patients with renal failure complicated by acute heart failure. It can quickly relieve the symptoms of heart failure, reduce the incidence of side effects and the cost of treatment in the intensive care unit, and improve the quality of life of patients. Thus, the ultrasonic dynamic monitoring of LPVC and NPVC has good social and economic benefits.
The datasets used and/or analyzed in the current study are available upon request from the respective authors.
Banerjee, D., Rosano, G. & Herzog, CA Management of heart failure patient with CKD. Banerjee, D., Rosano, G. & Herzog, CA Management of heart failure patient with CKD. Banerjee D., Rosano G. and Herzog K.A. Management of patients with heart failure and CKD. Banerjee D, Rosano G, and Herzog K. A. Management of patients with heart failure and CKD. clinical. Jam. Socialist Party. Renin. 16, 1131–1139 (2021).
Ferreira, J.P. et al. Practical management of acute heart failure and deterioration of kidney function in the emergency department. EURO. J. Emerge. medicine. leave. J. Euro. Socialist Party. Appear. medicine. 25, 229–236 (2017).
Ai, SH, Sofie, G., Bagshaw Sean, M., Kellum John, A. & Aj, HE Acute cardiorenal syndrome in acute heart failure: focus on renal replacement therapy. Ai, SH, Sofie, G., Bagshaw Sean, M., Kellum John, A. & Aj, HE Acute cardiorenal syndrome in acute heart failure: focus on renal replacement therapy. Ai, SH, Sofie, G., Bagshaw Sean, M., Kellum John, A. & Aj, HE Острый кардиоренальный синдром при острой сердечной недостаточности: акцент на заместительной почечной терапии. Ai, SH, Sofie, G., Bagshaw Sean, M., Kellum John, A. & Aj, HE Acute cardiorenal syndrome in acute heart failure: focus on renal replacement therapy. Ai, SH, Sofie, G., Bagshaw Sean, M., Kellum John, A. & Aj, HE 急性心力衰竭中的急性心肾综合征：专注于肾脏替代治疗。 Ai, SH, Sofie, G., Bagshaw Sean, M., Kellum John, A. & Aj, HE Ai, SH, Sofie, G., Bagshaw Sean, M., Kellum John, A. & Aj, HE Острый кардиоренальный синдром при острой сердечной недостаточности: акцент на заместительной почечной терапии. Ai, SH, Sofie, G., Bagshaw Sean, M., Kellum John, A. & Aj, HE Acute cardiorenal syndrome in acute heart failure: focus on renal replacement therapy. EURO. Heart G. Acute cardiovascular disease. Nursing 9, 802–811 (2020).
Siegwalt, F. et al. Clinical complications of permanent renal replacement therapy. contribute. Renin. 194, 109–117 (2018).
Duvris, A. et al. Mechanisms of hemodynamic instability associated with renal replacement therapy: a descriptive review. Intensive care medicine. 45, 1333–1346 (2019).
Reeves, PB & McCausland, FR Mechanisms, clinical implications, and treatment of intradialytic hypotension. Reeves, PB & McCausland, FR Mechanisms, clinical implications, and treatment of intradialytic hypotension. Reeves, P.B. and McCausland, F.R. Mechanisms, clinical consequences and treatment of intradialytic hypotension. Reeves, PB & McCausland, FR 机制、临床意义和透析中低血压的治疗。 Reeves, PB & McCausland, FR Reeves, P.B. and McCausland, F.R. Mechanisms, clinical implications and management of hypotension during dialysis. clinical. Jam. Socialist Party. Renin. 13, 1297–1303 (2018).
Vaish, H., Kumar, V., Anand, R., Chhapola, V. & Kanwal, SK The correlation between inferior vena cava diameter measured by ultrasonography and central venous pressure. Vaish, H., Kumar, V., Anand, R., Chhapola, V. & Kanwal, SK The correlation between inferior vena cava diameter measured by ultrasonography and central venous pressure. Vaish H., Kumar V., Anand R., Chapola V. and Kanwal S.K. Correlation between inferior vena cava diameter measured by ultrasound and central venous pressure. Vaish, H., Kumar, V., Anand, R., Chhapola, V. & Kanwal, SK 超声测量下腔静脉直径与中心静脉压之间的相关性。 Vaish, H., Kumar, V., Anand, R., Chhapola, V. & Kanwal, SK. Vaish, H., Kumar, V., Anand, R., Chapola, V. and Kanwal, S.K. Correlation between inferior vena cava diameter, measured by ultrasound, and central venous pressure. Indian J. Pediatrician. 84, 757–762 (2017).
Zhang, J. & Critchley, LA Inferior vena cava ultrasonography before General Anesthesia can predict hypotension after induction. Zhang, J. & Critchley, LA Inferior vena cava ultrasonography before General Anesthesia can predict hypotension after induction. Zhang, J. & Critchley, LA УЗИ нижней полой вены перед общей анестезией может предсказать гипотонию после индукции. Zhang, J. & Critchley, LA Ultrasonography of the inferior vena cava before general anesthesia may predict hypotension after induction. Zhang, J. & Critchley, LA 全身麻醉前的下腔静脉超声检查可以预测诱导后的低血压。 Zhang, J. & Critchley, LA Zhang, J. & Critchley, LA УЗИ нижней полой вены перед общей анестезией позволяет прогнозировать постиндуцированную гипотензию. Zhang, J. & Critchley, LA Ultrasound of the inferior vena cava before general anesthesia predicts post-induced hypotension. Anesthesiology 124, 580–589 (2016).
Bortolotti P. et al. Respiratory changes in the diameter of the inferior vena cava predict fluid response in spontaneously breathing patients with arrhythmias. install. Intensive Care 8, 79 (2018).