Predictive Effects Of Renal Resistive Index For AKI Undergoing Damage Control Resuscitation In Haemorrhage Shock

Objective:Over the past decade,domestic and foreign scholars have carried out a lot of research and Exploration on the treatment of severe traumatic hemorrhagic shock, which has changed a lot in the recovery and blood transfusion strategy. In the past, the classic shock recovery method can aggravate the acute traumatic coagulation disease due to the loss of blood and coagulation factors.Damage control resuscitation restricts early fluid resuscitation has been widely adopted as the preferred method of resuscitation in patients with uncontrolled haemorrhagic shock. Although this provides sub-optimal end organ perfusion,it is thought to facilitate haematological control and therefore increase the likelihood of survival.Our article looks at the prediction for acute kidny injury by real-time ultrasound evaluation was done. We hypothesized that doppler-based renal resistive index may help intensivists earlier diagnose AKI in these sever traumas patients.To our knowledge, the effects of early hemodynamic changes on the renal doppler RI had not been previously investigated in patients undergoing damage control resuscitation in uncontrolled haemorrhage shock with sever traumas.Methods:We studied sixty-two consecutive patients,undergoing uncontrolled major haemorrhage in sever traumas or polytrauma,admitted to a general intensive care unit were assessed under a ultrasonography protocol.All patients with traumatic hemorrhagic shock who need emergency surgery to stop bleeding after initial evaluation.ICU was admitted to the operation room after the initial assessment and resuscitation. In the initial entry into the ICU and the operation did not control the bleeding before the recovery were taken to the strategy of damage control recovery and the data of doppler-based renal resistive index were recorded.Blood samples were collected from peripheral arterial and obtain RRI at initial admission(T0),after operation(T1),and thethird postoperative day(T2).We assessed the performance of the Doppler renal resistive index(RRI) in each patient. At the same time,the severity score injury(ISS) score,operation mode, limited fluid resuscitation time, application of vasoactive drugs,renal function and prognosis were observed and recorded.The subjects for the left time in our own ICU were divided into three groups:no AKI、transient AKI and persistent AKI.The effect of the renal function in patients with severe traumatic hemorrhagic shock and renal function was analyzed by using statistical analysis, and the changes of renal arterial resistance index were evaluated by using the bedside renal ultrasound in real-time.Results: sixty-two uncontrolled major haemorrhage patients enrolled in the study,had no AKI 29,had transient AKI 19, and 13 had persistent AKI.At initial admission(T0),the no AKI and transient AKI group,as compared with the persistent AKI group,had higher injury severity score ISS(32.84±10.07 spots vs 21.03±5.94 spots;(P=0.001).After operations(T1),the no AKI and transient AKI group,as compared with the persistent AKI group, had higher renal Doppler RI(0.68±0.03 vs 0.79±0.04;P=0.001),after operations(T1),an RI 0.775 had a 84.6% sensitivity and 75.5% specificity for persistent AKI.The effect of the renal function in patients with severe traumatic hemorrhagic shock and renal function was analyzed by using statistical analysis, and the changes of renal arterial resistance index were evaluated by using the bedside renal ultrasound in real-time.Conclusions: undergoing uncontrolled major haemorrhage in sever traumas or polytrauma patients who are hemodynamically stable at admittance to the ICU after damage control resuscitation and operation, renal cortical blood flow redistribution occurs very early in response to uncontrolled bleeding and operation, might be noninvasively detected by using the renal doppler RRI.A renal doppler RRI higher than 0.775 is predictive of progression to persistent AKI in polytrauma patients. These exploratory results suggest that doppler renal RRI may be a promising tool for predicting the reversibility of AKI in sever traumas or polytrauma patients.