Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial - Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation Accéder directement au contenu
Article Dans Une Revue Annals of Intensive Care Année : 2021

Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial

1 HEGP - Hôpital Européen Georges Pompidou [APHP]
2 CHU Tenon [AP-HP]
3 CoRaKID - Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
4 CHU Pitié-Salpêtrière [AP-HP]
5 ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables
6 CIC Paris-Est - Centre d'investigation clinique Paris Est [CHU Pitié Salpêtrière]
7 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
8 CHU Pointe-à-Pitre/Abymes [Guadeloupe]
9 Centre Hospitalier René Dubos [Pontoise]
10 Hôpital Pellegrin
11 Centre Hospitalier Sud Francilien
12 CHU Angers - Centre Hospitalier Universitaire d'Angers
13 CHU Rouen
14 CHU Henri Mondor [Créteil]
15 UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12
16 CHU Gabriel Montpied [Clermont-Ferrand]
17 CHRO - Centre Hospitalier Régional d'Orléans
18 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
19 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
20 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
21 Centre Hospitalier Victor Dupouy
22 Hôpital Nord [CHU - APHM]
23 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
24 Hôpital de la Croix-Rousse [CHU - HCL]
25 CH Cholet - Centre Hospitalier de Cholet
26 CHIC - Centre Hospitalier Intercommunal de Créteil
27 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
28 Hôpital Louis Mourier - AP-HP [Colombes]
29 Service de Réanimation Médico-Chirurgicale [Avicenne]
Dorothée Carpentier
  • Fonction : Auteur
Jean-Marie Forel

Résumé

Background: Vascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury. Patients and methods: We performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected. Results: Among the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially (n = 319, 53%), followed by jugular (n = 256, 43%) and subclavian (n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34-4.07), p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98-1.00), p = 0.03]. Investigator site was also significantly associated with the choice of insertion site (p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64-1.25), p = 0.67]. Catheter dysfunction was the main reason for replacement (n = 47), followed by suspected infection (n = 29) which was actually seldom proven (n = 4). No mechanical complication (pneumothorax or hemothorax) occurred. Conclusion: Femoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.
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Origine : Publication financée par une institution

Dates et versions

hal-03194284 , version 1 (09-04-2021)

Identifiants

Citer

Nicolas Benichou, Saïd Lebbah, David Hajage, Laurent Martin-Lefèvre, Bertrand Pons, et al.. Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial. Annals of Intensive Care, 2021, 11 (1), pp.56. ⟨10.1186/s13613-021-00843-3⟩. ⟨hal-03194284⟩
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