scholarly journals Influence of mean arterial pressure and cardiac output on renal vascular tone reflected by the renal Doppler resistive index in critically ill patients

Critical Care ◽  
2015 ◽  
Vol 19 (S2) ◽  
Author(s):  
Raphael Augusto G de Oliveira ◽  
Leandro U Taniguchi ◽  
Marcelo Park ◽  
Pedro V Mendes
Keyword(s):  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vascular Tone ◽  
Resistive Index ◽  
Renal Vascular ◽  
Renal Doppler ◽  
Renal Vascular Tone

scholarly journals The evolution of mean arterial pressure in critically ill patients on vasopressors before and during a trial comparing a specific mean arterial pressure target to usual care

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie-Hélène Masse ◽  
Neill K. J. Adhikari ◽  
Xavier Théroux ◽  
Marie-Claude Battista ◽  
Frédérick D’Aragon ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Usual Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Hypertension ◽  
The Mean ◽  
Change In Mean

Abstract Background In randomized clinical controlled trials, the choice of usual care as the comparator may be associated with better clinician uptake of the study protocol and lead to more generalizable results. However, if care processes evolve to resemble the intervention during the course of a trial, differences between the intervention group and usual care control group may narrow. We evaluated the effect on mean arterial pressure of an unblinded trial comparing a lower mean arterial pressure target to reduce vasopressor exposure, vs. a clinician-selected mean arterial pressure target, in critically ill patients at least 65 years old. Methods For this multicenter observational study using data collected both prospectively and retrospectively, patients were recruited from five of the seven trial sites. We compared the mean arterial pressure of patients receiving vasopressors, who met or would have met trial eligibility criteria, from two periods: [1] at least 1 month before the trial started, and [2] during the trial period and randomized to usual care, or not enrolled in the trial. Results We included 200 patients treated before and 229 after trial initiation. There were no differences in age (mean 74.5 vs. 75.2 years; p = 0.28), baseline Acute Physiology and Chronic Health Evaluation II score (median 26 vs. 26; p = 0.47) or history of chronic hypertension (n = 126 [63.0%] vs. n = 153 [66.8%]; p = 0.41). Mean of the mean arterial pressure was similar between the two periods (72.5 vs. 72.4 mmHg; p = 0.76). Conclusions The initiation of a trial of a prescribed lower mean arterial pressure target, compared to a usual clinician-selected target, was not associated with a change in mean arterial pressure, reflecting stability in the net effect of usual clinician practices over time. Comparing prior and concurrent control groups may alleviate concerns regarding drift in usual practices over the course of a trial or permit quantification of any change.

scholarly journals Renal resistive index: a new reversible tool for the early diagnosis and evaluation of organ perfusion in critically ill patients: a case report

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Antonio Anile ◽  
Silvia Ferrario ◽  
Lorena Campanello ◽  
Maria Antonietta Orban ◽  
Giacomo Castiglione
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Target Therapy ◽  
Resistive Index ◽  
Hemodynamic Instability ◽  
Renal Resistive Index ◽  
Metabolic Parameter ◽  
Case Presentation ◽  
Invasive Hemodynamic Monitoring ◽  
Renal Doppler

Abstract Background We reported a case of early detection of peripheral hypoperfusion trough the evaluation of a new index in intensive care: Renal Doppler Resistive Index (RRI). Case presentation We admitted a 76-year-old man who underwent ileostomy and hernioplasty because of an intestinal occlusion due to obstructive strangulated right inguinal hernia. The post-operative period was characterised by hemodynamic instability and he needed an invasive hemodynamic monitoring, administration of vasopressors and continuous renal replacement therapy (CRRT). Then, hemodynamic stability was obtained and vasopressors interrupted. RRI was lower than 0.7. In the eleventh post-operative day, despite stable macrocirculatory parameters, we found increased values of RRI. An abdomen ultrasound first and then a CT scan revealed the presence of bleeding from the previous ileostomy. Hence, the patient immediately underwent another surgical operation. Conclusions RRI modification appears to be more precocious than any other hemodynamic, microcirculatory and metabolic parameter routinely used. RRI has been widely used to assess renal function in critically ill patients; now, we presume that RRI could represent a common and useful tool to manage target therapy in critical condition.

scholarly journals Searching Optimal Target of Perfusion Pressure for Managing Acute Kidney Injury in Critically Ill Patients: An Analysis of Three Large Open Databases

2020 ◽  
Author(s):  
Buyun Wu ◽  
Yudie Peng ◽  
Jin Liu ◽  
Ting Li ◽  
Kang Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Perfusion Pressure ◽  
Kidney Injury ◽  
Research Database ◽  
Optimal Target ◽  
Mimic Iii

Abstract Background: The optimal perfusion pressure target for acute kidney injury (AKI) in critically ill patients remains uncertain. We investigated the association between mean perfusion pressure (MPP) and AKI among critically ill patients and estimated its optimal range.Methods: We analyzed data stored in the Medical Information Mart for Intensive Care (MIMIC) -III, eICU Collaborative Research Database (eICU-CRD), and MIMIC-IV databases. Critically ill patients receiving invasive measurements of MPP for at least 12 hours within the first 24 hours of ICU stay were included. The exposure of interest was the time-weighted average MPP (TWA-MPP) in the first 24 hours. The primary outcome was the incidence of AKI in the next 48 hours. Results: We enrolled 7,992, 8,604, and 6,730 patients from the MIMIC-III, eICU-CRD, and MIMIC-IV databases, respectively. TWA-MPP had higher areas under the curve than mean arterial pressure in predicting AKI in the next 48 hours (0.63 vs 0.57, 0.62 vs 0.58, and 0.64 vs 0.58 in three databases, all p < 0.001). We observed the lowest adjusted risk of AKI when TWA-MPP above 72, 65, and 69 mmHg in the MIMIC-III, eICU-CRD, and MIMIC-IV databases, respectively. Pooled analyses indicated that per 10% increase of proportion of MPP above 65 mmHg was associated with decreased incidence of AKI (adjusted odds ratio = 0.93, 95% confidence interval = 0.92–0.94, p < 0.001). Furthermore, pooled analyses showed that the lowest risk of new-onset, persistence, and progression of AKI was estimated when TWA-MPP above 74, 70 and 65 mmHg, respectively. Conclusions: MPP outperformed mean arterial pressure as a perfusion predictor of AKI. MPP of 65 mmHg or higher may be the optimal target for managing AKI in critically ill patients. The target rises to higher when reversing or preventing AKI.

scholarly journals Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury

Critical Care ◽  
2012 ◽  
Vol 16 (5) ◽  
pp. R165 ◽  
Author(s):  
Antoine Dewitte ◽  
Julien Coquin ◽  
Bertrand Meyssignac ◽  
Olivier Joannès-Boyau ◽  
Catherine Fleureau ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Vascular Tone ◽  
Resistive Index ◽  
Kidney Injury ◽  
Renal Vascular ◽  
Renal Vascular Tone

Associations Between Mean Arterial Pressure and Poor ICU Outcomes in Critically Ill Patients With Cirrhosis

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kavish R. Patidar ◽  
Jennifer Lynn Peng ◽  
Francis Pike ◽  
Eric S. Orman ◽  
Mathew Glick ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients

Impact of Mean Arterial Pressure Fluctuation on Mortality in Critically Ill Patients

2018 ◽  
Vol 46 (12) ◽  
pp. e1167-e1174 ◽  
Author(s):  
Ya Gao ◽  
Qinfen Wang ◽  
Jiamei Li ◽  
Jingjing Zhang ◽  
Ruohan Li ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Pressure Fluctuation ◽  
Critically Ill Patients

scholarly journals Evaluating the clinical and cost-effectiveness of permissive hypotension in critically ill patients aged 65 years or over with vasodilatory hypotension: Protocol for the 65 randomised clinical trial

2020 ◽  
Vol 21 (4) ◽  
pp. 281-282
Author(s):  
Alvin Richards-Belle ◽  
Paul R Mouncey ◽  
Richard D Grieve ◽  
David A Harrison ◽  
M Zia Sadique ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomised Clinical Trial ◽  
Vasopressor Therapy ◽  
Permissive Hypotension ◽  
Risk Of Death ◽  
South Central

Vasodilatory shock is common in critically ill patients and vasopressors are a mainstay of therapy. A meta-analysis suggested that use of a higher, as opposed to a lower, mean arterial pressure target to guide titration of vasopressor therapy, could be associated with a higher risk of death in older critically ill patients. The 65 trial is a pragmatic, multi-centre, parallel-group, open-label, randomised clinical trial of permissive hypotension (a mean arterial pressure target of 60 -65 mmHg during vasopressor therapy) versus usual care in critically ill patients aged 65 years or over with vasodilatory hypotension. The trial is conducted in 2600 patients from 65 United Kingdom adult, general critical care units. The primary outcome is all-cause mortality at 90 days. An economic evaluation is embedded. The 65 trial received favourable ethical opinion from the South Central - Oxford C Research Ethics Committee and approval from the Health Research Authority. The results will be presented at national and international conferences and published in peer-reviewed medical journals. Trial registration: ISRCTN10580502

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