Kidney-ventilator interaction and kidney-protective ventilation

Purpose of review Invasive mechanical ventilation (IMV) is a cornerstone in the management of acute respiratory failure (ARF) and acute respiratory distress syndrome (ARDS); however, positive pressure ventilation (PPV) and injurious IMV can contribute to renal dysfunction. This review aims to summarize current evidence on kidney-ventilator interactions and explore strategies for kidney-protective ventilation. Recent findings The relationship between ARF/ARDS and acute kidney injury (AKI) is a major contributor to morbidity, mortality, and adverse outcomes among critically ill patients. PPV can induce hemodynamic and neurohormonal changes that may impair kidney function. Additionally, injurious IMV can exacerbate these effects and promote biotrauma, triggering inflammatory responses that further compromise kidney function. Conversely, AKI can exert both inflammatory and non-inflammatory effects, impairing pulmonary function. Lung-protective ventilation (LPV) using low tidal volume and conservative fluid management are strategies that may mitigate AKI. Extracorporeal organ support, including renal replacement therapy and extracorporeal membrane oxygenation, may facilitate LPV and be associated with improved outcomes in patients with IMV-associated AKI. Summary IMV influences lung-kidney interactions in a bidirectional manner. Evidence suggests the use of LPV, and extracorporeal organ support may mitigate dual organ injury. A thorough understanding of this interplay is essential to optimizing outcomes in critically ill patients receiving IMV.