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SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Acute kidney injury (AKI) is a major complication in the Coronavirus disease 2019 (COVID-19) We present a group of patients who, after requiring mechanical ventilation (MV) for COVID-19 respiratory failure, precipitously developed progressive AKI within 24 hours of intubation METHODS: Patients with confirmed COVID-19 and respiratory failure requiring MV were included Patients with a history of chronic kidney disease stage 3 or higher and end-stage renal disease were excluded Data was collected from the hospital medical records AKI diagnosis and staging were determined as per the Kidney Disease: Improving Global Outcomes (KDIGO) criteria RESULTS: A total of 15 patients were identified who had progressive AKI after being intubated for COVID-19 respiratory failure The median age of patients was 58 years [interquartile range (IQR) 52-65], 8 (53%) were men and average body-mass-index (BMI) was (32 9+9 9) Most common comorbidities were: hypertension 9 (60%), hyperlipidemia 6 (40%) and diabetes 6 (40%) The median hospital day when intubation was performed was 3rd day (IQR 2-4) MV was conducted according to ARDS mechanical ventilation guidelines None of the patients required vasopressors before MV, whereas, after intubation 13 patients (87%) required vasopressors The median number of vasopressors used was 2 All patients received propofol for sedation, with the addition of morphine in 12 patients, midazolam in 5 patients, fentanyl in 4 patients, and hydromorphone in 1 patient Paralytics were used in 7 patients The median intensive care length of stay was 9 days (IQR 5-12) All the patients had an elevated d-dimer [median 4300ng/ml (IQR 1662-25303), normal <230 ng/ml] and C-reactive protein (CRP) levels [median 343 mg/l (IQR 313-390), normal <8mg/l] 11/15 (73%) patients either received dialysis or had indications for dialysis and 12/15 (80%) patients died CONCLUSIONS: Patients with COVID-19 respiratory failure are at an increased risk for AKI with the initiation of MV While on MV, these patients had a high requirement for dialysis and a high mortality rate CRP and d-dimer were markedly elevated in all of these patients Possibly, oxygen toxicity and capillary endothelial damage with continuing high-pressure in the lungs from MV, triggered an inflammatory and thrombotic state leading to hypotension, sepsis, and subsequent AKI Other possible mechanisms for AKI could be direct viral cytotoxicity and iatrogenic causes (drugs) Correlation between the initiation of MV and AKI is peculiar and its pathophysiologic mechanisms need to be fully understood CLINICAL IMPLICATIONS: Because of the temporal association of severe AKI with the initiation of MV and possible causative role of MV in illness severity and death, physicians should strongly consider noninvasive respiratory support such as high flow nasal cannula in respiratory failure with COVID-19 DISCLOSURES: No relevant relationships by Maria Bernal Riera, source=Web Response No relevant relationships by Momcilo Durdevic, source=Web Response No relevant relationships by Dragana Durdevic, source=Web Response No relevant relationships by Amrah Hasan, source=Web Response No relevant relationships by Stephen Jesmajian, source=Web Response No relevant relationships by Ashutossh Naaraayan, source=Web Response No relevant relationships by Abhishek Nimkar, source=Web Response No relevant relationships by Andreea Constanta Stan, source=Web Response
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