Mean perfusion pressure deficit during the initial management of shock--an observational cohort study
Copyright © 2013 Elsevier Inc. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2013 |
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| Erschienen: |
2013 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:28 |
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| Enthalten in: |
Journal of critical care - 28(2013), 5 vom: 20. Okt., Seite 816-24 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Panwar, Rakshit [VerfasserIn] |
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| Links: |
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| Themen: |
Blood Pressure |
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| Anmerkungen: |
Date Completed 27.05.2014 Date Revised 21.03.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jcrc.2013.05.009 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM229122159 |
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| 245 | 1 | 0 | |a Mean perfusion pressure deficit during the initial management of shock--an observational cohort study |
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| 500 | |a Date Completed 27.05.2014 | ||
| 500 | |a Date Revised 21.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2013 Elsevier Inc. All rights reserved. | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Blood Pressure | |
| 650 | 4 | |a Intensive Care | |
| 650 | 4 | |a Perfusion | |
| 650 | 4 | |a Relative hypotension | |
| 650 | 4 | |a Targets | |
| 650 | 7 | |a Vasoconstrictor Agents |2 NLM | |
| 700 | 1 | |a Lanyon, Nicholas |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Andrew R |e verfasserin |4 aut | |
| 700 | 1 | |a Bailey, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Pilcher, David |e verfasserin |4 aut | |
| 700 | 1 | |a Bellomo, Rinaldo |e verfasserin |4 aut | |
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