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Kidney Week

Abstract: PO0821

Efficacy of Acute Continuous High-Volume Peritoneal Dialysis on the Respiratory Mechanics of a Mechanically Ventilated Patient with Acute Respiratory Distress Syndrome due to COVID-19

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Cao, Thanh, University of Southern California, Los Angeles, California, United States
  • Yanchuk, Viktoriya, University of Southern California, Los Angeles, California, United States
  • Sharma, Neeraj, University of Southern California, Los Angeles, California, United States

Group or Team Name

  • University of Southern California
Introduction

Acute renal failure (ARF) is a common issue in mechanically ventilated patients diagnosed with acute respiratory distress syndrome (ARDS) due to COVID-19. Renal replacement therapy (RRT) is often required for volume overload. Such patients may not tolerate hemodynamic shifts induced by hemodialysis (HD). Continuous renal replacement therapy (CRRT) while better tolerated is a limited resource. Acute peritoneal dialysis (PD) remains a feasible RRT modality in patients on mechanical ventilation. Some hesitate to use PD for fear of increasing intra-abdominal pressure (IAP) with dwells leading to altered respiratory mechanics. Our case demonstrates that acute PD has no adverse respiratory outcomes in a COVID-19 patient.

Case Description

A 42 year-old Hispanic male with end stage renal disease newly initiated on urgent start PD for 1 week presents with acute hypoxemic respiratory failure secondary to ARDS from COVID-19. Upon presentation, he was intubated and initiated on lung protective ventilator strategies. Due to high ventilatory requirements (PEEP 15, FiO2 100%) with severe volume overload HD was selected in lieu of PD. He underwent daily HD but remained overloaded due to high daily intake. Due to limited availability of CRRT, he was transitioned to acute continuous PD via cycler (fill volume 2L, every 4hr). FiO2 reduced to 40%, peak and plateau pressures did not change, and he was able to maintain adequate ventilation with unchanged tidal volumes while on PD. He eventually received a tracheostomy.

Discussion

COVID-19 has challenged providers with managing critically ill patients in the setting of limited resources. In our case of ARDS with ARF, we transitioned from HD to acute PD in order to facilitate fluid removal in lieu of CRRT. The ICU team feared increased IAP from PD would worsen lung compliance and hypoxemia from atelectasis. A prospective study by Almeida et al showed that acute PD in mechanically ventilated patients was associated with increased IAP, but lung compliance, oxygenation, and PaO2/FiO2 increased. Our case noted similar observations without adverse event. Acute PD was able to meet the demands on his daily intake without any compromise to ARDS lung protective ventilator strategies.