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.

Media Type:

Electronic Article

Year of Publication:

2013

Contained In:

Journal of critical care - Vol. 28, No. 5 (2013), p. 816-24

Language:

English

Contributors:

Panwar, Rakshit
Lanyon, Nicholas
Davies, Andrew R
Bailey, Michael
Pilcher, David
Bellomo, Rinaldo

Urls:

Volltext

Keywords:

Aged
Blood Pressure
Female
Humans
Intensive Care
Journal Article
Male
Multiple Organ Failure
Perfusion
Prospective Studies
Relative hypotension
Resuscitation
Shock
Targets
Treatment Outcome
Vasoconstrictor Agents

Notes:

Date Completed 27.05.2014

Date Revised 10.09.2013

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1016/j.jcrc.2013.05.009

PMID:

23849541

PPN (Catalogue-ID):

NLM229052444