key: cord-0704732-qsp9ph0d
authors: Dupont, Vincent; Gamblin, Claire; Bard, Mathieu; Julien, Gautier; Bonnivard, Michel; Champenois, Vanessa; Goury, Antoine; Mourvillier, Bruno
title: Severe intra-abdominal hypertension in critically-ill COVID-19 patients with acute kidney injury
date: 2021-03-18
journal: Chest
DOI: 10.1016/j.chest.2021.03.019
sha: 35a272d148c717c26e848b66e5560d6cf387d982
doc_id: 704732
cord_uid: qsp9ph0d

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The pathophysiology of COVID-19-related AKI remains incompletely elucidated and 92

is probably multifactorial 7 . The independent association between elevated IAP and renal 93 function impairment has been well established and is mainly explained by renal venous 94 congestion which impairs glomerular filtration by decreasing renal plasma flow 8 . As 95 previously reported, obesity, which concerns a large subset of critically-ill patients with 96 COVID-19, is an independent risk factor of IAH 6 . Describing a homogeneous population of 97 ventilated patients with COVID-19 who developed severe AKI during ICU stay, we found 98 that all of them had IAH at the time of AKI development. Besides, though we did not find 99 IAH grade III-IV to be significantly associated with worse outcomes, which might be due at 100 least in part to our small sample size, patients with severe IAH tended to show higher rates of 101 RRT and in ICU death. Furthermore, we found that IAP decreased significantly in univariate 102 analysis while decreasing fluid load and PEEP levels (both well-known IAH risk factors). The 103 use of high PEEP level in patients with almost normal compliance has been widely criticized 104 as it might increase transpulmonary pressures and decrease venous return without improving 105 oxygenation 1 . As PEEP adjustments are transmitted to the abdomen, the use of high PEEP has right-sided heart failure, thus contributing to IAH 9 . Thus, the optimal fluid and respiratory Renal replacement therapy, n(%) 7 (41.2) 1 (16.7) 6 (54.6) Mesenteric ischemia, n(%) 1 (5.9) 0 1 (9.0) ICU mortality, n(%) 11 (64.7) 3 (50) 8 (72.7)

Categorical and continuous variables are presented as N (%) and as median with interquartile range, respectively. IAH intra-abdominal hypertension, BMI body mass index, CKD chronic kidney disease, RAAS renin-angiotensin-aldosterone system, ICU intensive care unit, PEEP positive end-expiratory pressure, ECMO extracorporeal membrane oxygenation. Data are presented as median with interquartile range. Mann-Whitney test was used to compare

Management of COVID-19 Respiratory Distress

Acute Respiratory Distress Syndrome