Mean perfusion pressure deficit during the initial management of shock - an observational cohort study

Rakshit Panwar, Nicholas Lanyon, Andrew Ross Davies, Michael John Bailey, David V Pilcher, Rinaldo Bellomo

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Abstract

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.
Original languageEnglish
Pages (from-to)816 - 824
Number of pages9
JournalJournal of Critical Care
Volume28
Issue number5
DOIs
Publication statusPublished - 2013

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