کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5885872 | 1150928 | 2013 | 9 صفحه PDF | دانلود رایگان |
PurposeIt 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 MethodsFifty-one consecutive, non-trauma patients, aged â¥Â 40 years, with â¥Â 2 organ dysfunction and requiring vasopressor â¥Â 4 hours were observed at an academic intensive care unit. Mean MPP deficit [=%(basal MPP â achieved MPP)/basal MPP] and % time spent with > 20% MPP deficit were assessed during initial 72 vasopressor hours (T0-T72) for each patient.ResultsAchieved 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 (â¥Â 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).ConclusionsAchieved 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.
Journal: Journal of Critical Care - Volume 28, Issue 5, October 2013, Pages 816-824