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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| Veröffentlicht in: | Intensive care medicine Jg. 46; H. 4; S. 654 - 672 |
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.04.2020
Springer Springer Nature B.V |
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| ISSN: | 0342-4642, 1432-1238, 1432-1238 |
| Online-Zugang: | Volltext |
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| Abstract | 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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| AbstractList | 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. 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. 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). 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. 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. 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).BACKGROUNDMulti-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).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.METHODSA 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.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.CONCLUSIONThe 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. BackgroundMulti-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).MethodsA 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.ConclusionThe 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. 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). 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. 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. |
| Audience | Academic |
| Author | Joannidis, Michael Forni, Lui G. Darmon, Michael Ding, Xiaoqiang Staudinger, Thomas Bagshaw, Sean M. Hoste, Eric Ronco, Claudio Cantaluppi, Vincenzo Murray, Patrick T. Singbartl, Kai Welte, Tobias Kellum, John A. Prowle, John Ostermann, Marlies Lubnow, Matthias Husain-Syed, Faeq Meersch, Melanie Klein, Sebastian J. Fuhrmann, Valentin Ricci, Zaccaria Honore, Patrick M. Kashani, Kianoush Maggiorini, Marco |
| Author_xml | – sequence: 1 givenname: Michael orcidid: 0000-0002-6996-0881 surname: Joannidis fullname: Joannidis, Michael email: michael.joannidis@i-med.ac.at organization: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck – sequence: 2 givenname: Lui G. surname: Forni fullname: Forni, Lui G. organization: Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust – sequence: 3 givenname: Sebastian J. surname: Klein fullname: Klein, Sebastian J. organization: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Doctoral College Medical Law and Healthcare, Faculty of Law, University Innsbruck – sequence: 4 givenname: Patrick M. surname: Honore fullname: Honore, Patrick M. organization: Department of Intensive Care Medicine, CHU Brugmann University Hospital – sequence: 5 givenname: Kianoush surname: Kashani fullname: Kashani, Kianoush organization: Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic – sequence: 6 givenname: Marlies surname: Ostermann fullname: Ostermann, Marlies organization: Department of Critical Care, King’s College London, Guy’s and St Thomas’ Hospital – sequence: 7 givenname: John surname: Prowle fullname: Prowle, John organization: Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London – sequence: 8 givenname: Sean M. surname: Bagshaw fullname: Bagshaw, Sean M. organization: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta – sequence: 9 givenname: Vincenzo surname: Cantaluppi fullname: Cantaluppi, Vincenzo organization: Nephrology, Dialysis and Kidney Transplantation Unit, Department of Translational Medicine, University of Eastern Piedmont “A. Avogadro”, Maggiore della Carità University Hospital – sequence: 10 givenname: Michael surname: Darmon fullname: Darmon, Michael organization: Medical ICU, Saint-Louis University Hospital, AP-HP, Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM – sequence: 11 givenname: Xiaoqiang surname: Ding fullname: Ding, Xiaoqiang organization: Department of Nephrology, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University – sequence: 12 givenname: Valentin surname: Fuhrmann fullname: Fuhrmann, Valentin organization: Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Department of Medicine B, University Muenster – sequence: 13 givenname: Eric surname: Hoste fullname: Hoste, Eric organization: ICU, Ghent University Hospital, Research Fund-Flanders (FWO) – sequence: 14 givenname: Faeq surname: Husain-Syed fullname: Husain-Syed, Faeq organization: Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg – sequence: 15 givenname: Matthias surname: Lubnow fullname: Lubnow, Matthias organization: Department of Cardiology, Pulmonary and Critical Care Medicine, University Hospital Regensburg – sequence: 16 givenname: Marco surname: Maggiorini fullname: Maggiorini, Marco organization: Medical Intensive Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich – sequence: 17 givenname: Melanie surname: Meersch fullname: Meersch, Melanie organization: Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster – sequence: 18 givenname: Patrick T. surname: Murray fullname: Murray, Patrick T. organization: School of Medicine, University College Dublin, UCD Catherine McAuley Education and Research Centre – sequence: 19 givenname: Zaccaria surname: Ricci fullname: Ricci, Zaccaria organization: Department of Cardiology and Cardiac Surgery, Paediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS – sequence: 20 givenname: Kai surname: Singbartl fullname: Singbartl, Kai organization: Department of Critical Care Medicine, Mayo Clinic – sequence: 21 givenname: Thomas surname: Staudinger fullname: Staudinger, Thomas organization: Department of Medicine I, Medical University of Vienna, Vienna General Hospital – sequence: 22 givenname: Tobias surname: Welte fullname: Welte, Tobias organization: Klinik für Pneumologie, Medizinische Hochschule Hannover – sequence: 23 givenname: Claudio surname: Ronco fullname: Ronco, Claudio organization: Department of Medicine, University of Padova, International Renal Research Institute of Vicenza, San Bortolo Hospital, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital – sequence: 24 givenname: John A. surname: Kellum fullname: Kellum, John A. organization: Center for Critical Care Nephrology, University of Pittsburgh |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31820034$$D View this record in MEDLINE/PubMed |
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Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive... Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical... Background Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive... BackgroundMulti-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive... |
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| Title | Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup |
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