Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography.
OBJECTIVE
To determine the effects of increasing mean arterial pressure (MAP) on renal resistances assessed by Doppler ultrasonography in septic shock.


METHODS
Prospective, single-center, nonrandomized, open-label trial in the surgical intensive care unit in a university teaching hospital.


METHODS
11 patients with septic shock who required fluid resuscitation and norepinephrine to increase and maintain MAP at or above 65 mmHg.


METHODS
Norepinephrine was titrated in 11 patients in septic shock during three consecutive not randomized periods of 2 h to achieve a MAP at successively 65, 75, and 85 mmHg.


RESULTS
At the end of each period hemodynamic parameters and renal function variables (urinary output, creatinine, clearance) were measured, and Doppler ultrasonography was performed on interlobar arteries to assess the renal resistive index. When increasing MAP from 65 to 75 mmHg, urinary output increased significantly from 76 +/- 64 to 93 +/- 68 ml/h and the resistive index significantly decreased from 0.75 +/- 0.07 to 0.71 +/- 0.06. No difference was found between 75 and 85 mmHg.


CONCLUSIONS
Doppler ultrasonography and resistive index measurements may help determine in each patient the optimal MAP for renal blood flow and may be a relevant end-point to titrate the hemodynamic treatment in septic shock.
Deruddre
Stéphane
S
Université Paris XI, Département d'Anesthésie-Réanimation, Hôpital Bicêtre, AP-HP, 94275, Le Kremlin-Bicêtre, France.
Cheisson
Gaëlle
G
Mazoit
Jean-Xavier
JX
Vicaut
Eric
E
Benhamou
Dan
D
Duranteau
Jacques
J
D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011446:Prospective Studies; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D018608:Ultrasonography, Doppler; D014554:Urination; D014655:Vascular Resistance / Q000187:drug effects* / Q000502:physiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D003404:Creatinine; D009638:Norepinephrine