Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

Background Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). Methods A consensus conferen...

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Published in:Intensive care medicine Vol. 46; no. 4; pp. 654 - 672
Main Authors: Joannidis, Michael, Forni, Lui G., Klein, Sebastian J., Honore, Patrick M., Kashani, Kianoush, Ostermann, Marlies, Prowle, John, Bagshaw, Sean M., Cantaluppi, Vincenzo, Darmon, Michael, Ding, Xiaoqiang, Fuhrmann, Valentin, Hoste, Eric, Husain-Syed, Faeq, Lubnow, Matthias, Maggiorini, Marco, Meersch, Melanie, Murray, Patrick T., Ricci, Zaccaria, Singbartl, Kai, Staudinger, Thomas, Welte, Tobias, Ronco, Claudio, Kellum, John A.
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2020
Springer
Springer Nature B.V
Subjects:
Acute Disease
Acute Kidney Injury - therapy
Acute respiratory distress syndrome
Anesthesiology
Austria
Conference Reports and Expert Panel
Critical Care Medicine
Critical Illness
Crosstalk
Emergency Medicine
Epidemiology
Extracorporeal membrane oxygenation
Fluid management
Humans
Illnesses
Intensive
Intensive care
Kidney
Kidney diseases
Kidneys
Lung
Lungs
Mechanical ventilation
Medical colleges
Medical equipment and supplies industry
Medical test kit industry
Medicine
Medicine & Public Health
Oxygenation
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Renal function
Respiratory agents
Respiratory distress syndrome
Respiratory failure
Respiratory therapy
Ventilation
Ventilators
Austria
Canada
United Kingdom
France
United States
Germany
Acute respiratory distress syndrome
Extracorporeal membrane oxygenation
Renal replacement therapy
Water-electrolyte balance
Acute kidney injury
ISSN:0342-4642, 1432-1238, 1432-1238
Online Access:Get full text
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Summary:Background Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). Methods A consensus conference on the spectrum of lung–kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. Conclusion The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung–kidney interactions to improve care processes and outcomes in critical illness.
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ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-019-05869-7