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Association between ventilatory ratio and subsequent development of severe late acute kidney injury in acute respiratory distress syndrome.
Pubmed ID: 41765736
Journal: Medicina intensiva
Publication Date: Feb. 28, 2026
Authors: Siempos II, Kotanidou A, Papoutsi E, Andrianopoulos I, Kokkoris S, Charalampaki E, Dimopoulou I, Siampanos A, Kolonia K
Cite As: Kokkoris S, Papoutsi E, Andrianopoulos I, Siampanos A, Kolonia K, Charalampaki E, Kotanidou A, Dimopoulou I, Siempos II. Association between ventilatory ratio and subsequent development of severe late acute kidney injury in acute respiratory distress syndrome. Med Intensiva (Engl Ed) 2026 Feb 28: 502440. Epub 2026 Feb 28.
Studies:
- Acute Respiratory Distress Network (ARDSNet) Studies 01 and 03 Lower versus higher tidal volume, ketoconazole treatment and lisofylline treatment (ARMA/KARMA/LARMA)
- Acute Respiratory Distress Network (ARDSNet) Studies 06 and 08 Prospective, Randomized, Multicenter Trial of Aerosolized Albuterol Versus Placebo for the Treatment of Acute Lung Injury (ALTA)
- Acute Respiratory Distress Network (ARDSNet) Studies 07, 08, 09, 11, and 12 Early Versus Delayed Enteral Feeding to Treat People with Acute Lung Injury or Acute Respiratory Distress Syndrome (EDEN)
- Acute Respiratory Distress Network (ARDSNet) Studies 10 and 12 Statins for Acutely Injured Lungs from Sepsis (SAILS)
- Acute Respiratory Distress Network (ARDSNet) Study 04 Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury (ALVEOLI)
- Acute Respiratory Distress Network (ARDSNet) Study 05 Fluid and Catheter Treatment Trial (FACTT)
- Prevention and Early Treatment of Acute Lung Injury (PETAL) Network – Reevaluation of Systemic Early Neuromuscular Blockade (ROSE)
Abstract
OBJECTIVE: To investigate the association of a dead space ventilation index, namely ventilatory ratio (VR), with subsequent development of severe late acute kidney injury (AKI). DESIGN: Multicenter retrospective study. Secondary analysis of individual patient-level data from seven ARDS Network and PETAL Network randomized controlled trials. SETTING: Critically ill patients with ARDS. PATIENTS: We compared patients who developed severe AKI (stage II or III) more than two days but no longer than seven days following ARDS onset ("severe late AKI" group) with patients who did not develop severe late AKI ("no severe late AKI" group). INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: VR, severe late AKI. RESULTS: Of 3007 patients with ARDS included in the study, 376 (12.5%) developed severe late AKI. Baseline VR was independently associated with severe late AKI development [odds ratio (OR) 1.712, CI 1.096-2.674, p = 0.018)]. An adjusted linear mixed effects model revealed that trajectory of VR was higher in patients who developed severe late AKI than those who did not (estimate = 0.23, p < 0.001). Adjusted latent class mixed modeling identified two distinct trajectories of VR evolution over time, class 1 with lower trajectory over time, and class 2 with higher trajectory, which was independently associated with an increased risk of severe late AKI (OR 2.55, 95% CI 1.02-6.41, p = 0.046) compared to class 1. CONCLUSIONS: In ARDS, baseline value of VR was independently associated with severe late AKI, while its trajectory was significantly higher in patients who developed severe late AKI than those who did not.