Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial - 08/01/26
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
Background |
Vascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury.
Patients and methods |
We performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected.
Results |
Among the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially ( n = 319, 53%), followed by jugular ( n = 256, 43%) and subclavian ( n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34–4.07), p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98–1.00), p = 0.03]. Investigator site was also significantly associated with the choice of insertion site ( p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64—1.25), p = 0.67]. Catheter dysfunction was the main reason for replacement ( n = 47), followed by suspected infection ( n = 29) which was actually seldom proven ( n = 4). No mechanical complication (pneumothorax or hemothorax) occurred.
Conclusion |
Femoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.
Le texte complet de cet article est disponible en PDF.Keywords : Renal replacement therapy, Acute kidney injury, Vascular access, Catheter, Critical care
Keywords : Medical and Health Sciences, Clinical Sciences
Plan
Vol 11 - N° 1
Article 56- 2021 Retour au numéro
Article précédent
- Circadian rhythms in septic shock patients
- Gunnar Lachmann, Bharath Ananthasubramaniam, Viktor A. Wünsch, Lara-Marie Scherfig, Clarissa von Haefen, Cornelia Knaak, Andreas Edel, Lukas Ehlen, Barbara Koller, Anton Goldmann, Hanspeter Herzel, Achim Kramer, Claudia Spies
- Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper
- Jean-Luc Fellahi, Emmanuel Futier, Camille Vaisse, Olivier Collange, Olivier Huet, Jerôme Loriau, Etienne Gayat, Benoit Tavernier, Matthieu Biais, Karim Asehnoune, Bernard Cholley, Dan Longrois
Bienvenue sur EM-consulte, la référence des professionnels de santé.