الفهرس 
Acute kidney injuryOnly 14 pages are availabe for public view
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Abstract
Acute Kidney Injury (AKI) is a frequently encountered condition in hospitalized patients specially critically ill patients in ICUs. This condition is not a single organ failure but it is a multi-organ syndrome as AKI negatively affects many other organs.
AKI has many different etiologies:
1. Pre-renal as in hypovolemia, Impaired cardiac function and systemic vasodilatation.
2. Post-renal: it could be extra-renal compression as in prostatic hypertrophy, tumors and retroperitoneal fibrosis, or intra-renal obstruction as stones or blood clots.
3. Renal (intrinsic) causes: which sub-divided into: tubular, glomerular, interstitial or vas-cular.
Many of these etiologies are common in critically ill patients who suffer from other different co-morbidities and can cause any degree of AKI up to end-stage renal disease which requires renal replacement therapy and may even lead to death. Hence, AKI is considered a burden on health care systems all over the world and a leading cause in increased mortality rates in ICU patients.
The relationship between AKI and ALI is usually noted during our practice in ICU. As AKI affects the lungs, specially unhealthy ventilated lungs, in many different mechanisms. Such as: volume overload, acid-base imbalance, electrolytes disturbance, uremic and other toxins accumulation negatively affects the lungs, inflammatory mediators released by injured kidney can directly causes inflammatory response on the lungs. These and other proposed mechanisms show the direct effect of AKI on the respiratory function.
Combined with Acute Lung Injury (ALI), AKI worsens the prognosis of these patients. As it delays recovery and weaning of mechanically ventilated patients. Also AKI & ALI together have much higher mortality rate the either of them alone.
Mechanical ventilation (MV) is a life saving common practice in ICU which is used to manage respiratory failure due to any cause. The primary aim of MV is to help the patient to breathe mechanically until he can eventually breathe on his own.
Initiation of MV is well established among critical care doctors. But weaning from MV is more difficult process. As it requires many conditions to be available so the doctor can perform a spontaneous breathing trial (SBT). Which can be done on specific mode in the ventilators or via T-tubes.
In our study we chose to investigate the effect of AKI on respiratory system. Specifically on the mechanically ventilated patients and how AKI would affect the weaning of these patients. This observational prospective study was designed to asses the effect of AKI on weaning from mechanical ventilation by comparing the weaning of mechanically ventilated patients with normal kidney function with others who suffered from AKI.
Our study sample was 150 mechanically ventilated patients. They were divided into 2 groups according to their renal function:
group A: 50 patients with normal kidney function
group B: 100 patients suffered from AKI at any point during their admission.
Serum Creatinin (SCr) and urine output was routinely recorded at admission and every 24 hours.
AKI was defined as increase in SCr by ≥ 0.3 mg/dl (≥ 26.5 mmol/l) within 48 hours; or Increase in SCr to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days and/or urine excretion less than 400 mL/day.
Trial of weaning was conducted when the following criteria were fulfilled:
• Low FiO2 (< 0.5) with PaO2 > 80 mmHg.
• PEEP< 8 CmH2O.
• Hemodynamic stability (little to no inopressors)
• Ability to initiate spontaneous breathing (good neuromuscular function).
• Adequate conscious level, GSC ≥ 8.Duration of MV, duration of weaning, rate of weaning failure and mortality rates were recorded among other data such as demographic data, SAPS score at admission, cause of admission and co-morbidities. These data were statistically analyzed between the 2 groups.
As regard demographic data, SAPS score, cause of admission and co-morbidities, they all showed no statistical significant difference between the 2 groups.
As regard duration of MV and duration of weaning (length of time elapsed from the moment the patient reached weaning criterion to the time the patient was extubated), there were significant statistical difference between the two groups. As the group of patients suffered from AKI lasted longer on MV and had longer duration of weaning.
As regard rate of weaning failure, it was significantly higher in AKI patients (group A). While successful first time weaning was higher in non AKI patients (group B).
Mortality rate was also significantly higher in patients was AKI (group A) than non AKI patients (group B).
In conclusion, AKI has significant deleterious effect on respiratory system. Which is clearly seen in our resulted. As AKI significantly worsened the outcome of mechanically ventilated patients regarding days of MV, weaning failure and up to mortality rates.