PURPOSE: It is unclear if blood pressure targets for patients with shock should be adjusted to pre-morbid levels. We aimed to investigate mean deficit between the achieved mean perfusion pressure (MPP) in vasopressor-treated patients and their estimated basal (resting) MPP, and assess whether MPP deficit has any association with subsequent acute kidney injury (AKI). MATERIALS AND METHODS: Fifty-one consecutive, non-trauma patients, aged ≥40 years, with ≥2 organ dysfunction and requiring vasopressor≥4 hours were observed at an academic intensive care unit. Mean MPP deficit [=%(basal MPP-achieved MPP)/basal MPP] and % time spent with >20% MPP deficit were assessed during initial 72 vasopressor hours (T0-T72) for each patient. RESULTS: Achieved MPP was unrelated to basal MPP (P=.99). Mean MPP deficit was 18% (95% CI 15-21). Patients spent 48% (95% CI 39-57) time with >20% MPP deficit. Despite similar risk scores at T0, subsequent AKI (≥2 RIFLE class increase from T0) occurred more frequently in patients with higher (>median) MPP deficit compared to patients with lower MPP deficit (56% vs 28%; P=.045). Incidence of subsequent AKI was also higher among patients who spent greater % time with >20% MPP deficit (P=.04). CONCLUSIONS: Achieved blood pressure during vasopressor therapy had no relationship to the pre-morbid basal level. This resulted in significant and varying degree of relative hypotension (MPP deficit), which could be a modifiable risk factor for AKI in patients with shock.
PURPOSE: It is unclear if blood pressure targets for patients with shock should be adjusted to pre-morbid levels. We aimed to investigate mean deficit between the achieved mean perfusion pressure (MPP) in vasopressor-treated patients and their estimated basal (resting) MPP, and assess whether MPP deficit has any association with subsequent acute kidney injury (AKI). MATERIALS AND METHODS: Fifty-one consecutive, non-traumapatients, aged ≥40 years, with ≥2 organ dysfunction and requiring vasopressor≥4 hours were observed at an academic intensive care unit. Mean MPP deficit [=%(basal MPP-achieved MPP)/basal MPP] and % time spent with >20% MPP deficit were assessed during initial 72 vasopressor hours (T0-T72) for each patient. RESULTS: Achieved MPP was unrelated to basal MPP (P=.99). Mean MPP deficit was 18% (95% CI 15-21). Patients spent 48% (95% CI 39-57) time with >20% MPP deficit. Despite similar risk scores at T0, subsequent AKI (≥2 RIFLE class increase from T0) occurred more frequently in patients with higher (>median) MPP deficit compared to patients with lower MPP deficit (56% vs 28%; P=.045). Incidence of subsequent AKI was also higher among patients who spent greater % time with >20% MPP deficit (P=.04). CONCLUSIONS: Achieved blood pressure during vasopressor therapy had no relationship to the pre-morbid basal level. This resulted in significant and varying degree of relative hypotension (MPP deficit), which could be a modifiable risk factor for AKI in patients with shock.
Authors: François Lamontagne; Maureen O Meade; Paul C Hébert; Pierre Asfar; François Lauzier; Andrew J E Seely; Andrew G Day; Sangeeta Mehta; John Muscedere; Sean M Bagshaw; Niall D Ferguson; Deborah J Cook; Salmaan Kanji; Alexis F Turgeon; Margaret S Herridge; Sanjay Subramanian; Jacques Lacroix; Neill K J Adhikari; Damon C Scales; Alison Fox-Robichaud; Yoanna Skrobik; Richard P Whitlock; Robert S Green; Karen K Y Koo; Teddie Tanguay; Sheldon Magder; Daren K Heyland Journal: Intensive Care Med Date: 2016-02-18 Impact factor: 17.440
Authors: Felix Kork; Felix Balzer; Claudia D Spies; Klaus-Dieter Wernecke; Adit A Ginde; Joachim Jankowski; Holger K Eltzschig Journal: Anesthesiology Date: 2015-12 Impact factor: 7.892
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