Patologìâ (Aug 2024)
US-individualized infusion therapy in geriatric patients after emergency abdominal surgery: effect on the development of acute kidney injury
Abstract
In most elderly patients, prescribing the necessary volume of infusion therapy for the prevention of prerenal acute kidney injury (AKI) requires individualization. It is considered that ultrasound examination of the inferior vena cava (IVC) can be an effective additional method of assessing volemia in this category of patients. The aim is to determine the effectiveness of infusion therapy based on ultrasound of the inferior vena cava for the prevention of AKI in geriatric patients after urgent abdominal surgery. Materials and methods. A prospective single-center study included 50 patients (74.5 (68.0; 81.0) y. o.), divided into 2 groups: group A (n = 25, infusion therapy based on ultrasound of the IVC); group B (n = 25, infusion therapy based on changes in hemodynamic parameters and diuresis). The diameter of the IVC was determined using ultrasonography (ultrasound probe CN-6, SIEMENS, Acuson Antares), hemodynamic parameters were assessed using esCOO technology (Vismo PVM-2701K monitor, Nihon Kohden, Japan). The KDIGO classification was used to determine the presence and stage of AKI. Statistical analysis was performed using the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. The daily volume of infusion therapy in group A was 150 ml more than in group B (p = 0.049). Group A patients had 1.2 times higher CI (p = 0.016), by 6 mm Hg higher MAP (p = 0.012), 1.3 times greater SV (p < 0.001) than patients in group B. Also, they required 2 times less use of vasopressors (p = 0.026) and 2.8 times less use of diuretics (p = 0.008). Correlation between SV, CI, MAP and IVC diameter was weak but significant (r = 0.35, r = 0.25, r = 0.29, respectively, p ˂ 0.05). The incidence and severity of AKI did not differ between the study groups. In group A, the intensive care unit stay was 42 (35; 102) hours versus 80 (48; 176) hours in group B (p = 0.028) and survival rate was 88 % versus 40 %, respectively (p = 0.004). Conclusions. Infusion therapy based on ultrasound of the inferior vena cava may be effective in geriatric patients after urgent abdominal surgery in the intensive care unit. The assessment of volemia based on the determination of the maximum diameter of the IVC is a good additional criterion for the individualization of the volume of postoperative infusion therapy aimed directly at the optimization of systemic hemodynamics and indirectly at the prevention of AKI.
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