ArticleJournal of intensive care2025
PEEP-AKI-COVID ICU: Effect of positive end-expiratory pressure on acute kidney injury development in patients with COVID-19-associated acute respiratory distress syndrome: an ancillary analysis of the COVID-ICU study.
Article in Journal of intensive care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Ventilator-Associated Pneumonia: The Role of Kidney-Lung Crosstalk and Renal Replacement Therapy, a Narrative Review.Journal of clinical medicine · 2026Review
- Association between prognostic nutritional index and 28-day mortality in patients with sepsis-associated acute respiratory distress syndrome.Frontiers in nutrition · 2026Article
- Impact of diabetes mellitus and glucose level control on early sepsis-associated acute kidney injury: a multicenter retrospective observational study.Frontiers in medicine · 2026Article
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7 authors.
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Abstract
backgroundAcute Kidney Injury (AKI) is common in patients admitted to the intensive care unit (ICU) for severe SARS-CoV-2 pneumonia and is associated with a worse prognosis. Mechanical ventilation has been identified as a risk factor for renal damage in COVID-19. However, few studies have examined the specific ventilatory settings involved. We hypothesized that positive end-expiratory pressure (PEEP) may contribute to the onset of AKI. Our primary objective was to assess the relationship between PEEP levels and the development of AKI in critically ill patients with COVID-19-related ARDS.
methodsWe conducted an ancillary analysis of the international, prospective, multicenter COVID-ICU study, which included 4244 COVID-19 ICU patients across 149 intensive care units. For our study, only patients who underwent mechanical ventilation for at least 48 h and had normal renal function before intubation were included. The primary outcome was AKI, defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. A multivariable logistic regression model was used to evaluate the association between PEEP levels and the development of AKI (KDIGO score > 1).
resultsA total of 1,066 patients were included in the analysis. Among them, 510 (48%) developed AKI within the first 5 days after intubation. After multivariable adjustment, higher daily mean PEEP levels, averaged over the first 3 days of mechanical ventilation and treated as a continuous variable, were independently associated with the development of AKI (odds ratio [OR] 1.10; 95% confidence interval [CI] 1.05-1.16). A PEEP level exceeding 15.2 cmH
conclusionIn patients with COVID-19-related ARDS patients, higher PEEP levels within the first 5 days after intubation were independently associated with AKI. These findings underscore the importance of ventilatory strategies to balance oxygenation and kidney protection.
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