naa a22 4500 510742904 CHVBK 20180411083034.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s12630-013-9912-z doi (NATIONALLICENCE)springer-10.1007/s12630-013-9912-z Cerebrovascular autoregulation in critically ill patients during continuous hemodialysis [Elektronische Daten] [Patrick Schramm, Dorothea Closhen, Janosch Wojciechowski, Manfred Berres, Klaus Klein, Marc Bodenstein, Christian Werner, Kristin Engelhard] L'autorégulation vasculaire cérébrale chez les patients gravement malades pendant l'hémodialyse continue Purpose: In chronic renal failure, intermittent hemodialysis decreases cerebral blood flow velocity (CBFV); however, in critically ill patients with acute renal failure, the effect of continuous venovenous hemodialysis (CVVHD) on CBFV and cerebrovascular autoregulation (AR) is unknown. Therefore, a study was undertaken to investigate the potential effect of CVVHD on CBFV and AR in patients with acute renal failure. Methods: This cohort study investigated 20 patients with acute renal failure who required CVVHD. In these patients, the CBFV and index of AR (Mx) were measured using transcranial Doppler before and during CVVHD. Results: The median Mx values at baseline were 0.33 [interquartile range (IQR): 0.02-0.55], and during CVVHD, they were 0.20 [0.07-0.40]. The differences in Mx (CVVHD - baseline) was (median [IQR]) −0.015 [−0.19-0.05], 95% confidence interval (CI) −0.16 to 0.05. The Mx was>0.3 in 11/20 patients at baseline measurement. Six of these patients recovered to Mx<0.3 during CVVHD. The CBFV was (median [IQR]) 47 [36-59] cm·sec−1 at baseline and 49 [36-66] cm·sec−1 during CVVHD. The difference of CBFV was 0.0 [−4 - 2.7], 95% CI −2.5 to 4.2. Conclusion: Compared with patients with intermittent hemodialysis, CVVHD did not influence CBFV and AR in critically ill patients with acute renal failure, possibly due to lower extracorporeal blood flow, slower change of plasma osmolarity, and a lower fluid extraction rate. In a subgroup of patients with sepsis, the AR was impaired at baseline in more than half of the patients, and this was reversed during CVVHD. The trial was registered at ClinicalTrials.gov ID: NCT01376531. Canadian Anesthesiologists' Society, 2013 Schramm Patrick Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut Closhen Dorothea Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut Wojciechowski Janosch Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut Berres Manfred Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany aut Klein Klaus Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut Bodenstein Marc Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut Werner Christian Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut Engelhard Kristin Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/6(2013-06-01), 564-569 0832-610X 60:6<564 2013 60 12630 https://doi.org/10.1007/s12630-013-9912-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9912-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Schramm Patrick Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut NATIONALLICENCE 700 1- Closhen Dorothea Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut NATIONALLICENCE 700 1- Wojciechowski Janosch Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut NATIONALLICENCE 700 1- Berres Manfred Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany aut NATIONALLICENCE 700 1- Klein Klaus Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut NATIONALLICENCE 700 1- Bodenstein Marc Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut NATIONALLICENCE 700 1- Werner Christian Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut NATIONALLICENCE 700 1- Engelhard Kristin Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/6(2013-06-01), 564-569 0832-610X 60:6<564 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer