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J Crit Care. 2013 Oct;28(5):816-24. doi: 10.1016/j.jcrc.2013.05.009. Epub 2013 Jul 10.

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

Author information

1
Department of Anaesthesia, Intensive Care and Pain Medicine, John Hunter Hospital, Newcastle 2305, Australia. Electronic address: rakshitpanwar@hotmail.com.

Abstract

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.

KEYWORDS:

Blood Pressure; Intensive Care; Perfusion; Relative hypotension; Targets

PMID:
23849541
DOI:
10.1016/j.jcrc.2013.05.009
[Indexed for MEDLINE]
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