Measurement of kidney perfusion in critically ill Patients

Melissaki, A; Kyriakopoulou, T; Kupcova, E; Efthymiou, Anna; Kribeni, G; Sartzi, M; Kardamis, Ch

doi:10.1186/cc1259

Cited by 15 publications

(8 citation statements)

References 60 publications

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“…Measuring renal congestion by imaging is challenging at the bedside and requires extensive patient manipulation, which, in the critically ill patient greatly reduces the practical applicability of any given technique [17]. Based on our data, we suggest that a calculated MPP ≤59 mmHg in the early phase of AKI I may serve as a surrogate marker of increased risk for progression to AKI stage III.…”

Section: Discussionmentioning

confidence: 95%

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Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients – A retrospective analysis

2017

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BackgroundThe aim was to investigate whether mean perfusion pressure (MPP) calculated as the difference between mean arterial pressure (MAP) and central venous pressure (CVP) was associated with risk of progression from AKI I to AKI III in critically ill patients.MethodsRetrospective analysis of adult patients admitted to a multi-disciplinary adult intensive care unit (ICU) between July 2007 and June 2009 who developed AKI I and in whom advanced haemodynamic monitoring was initiated within 12 h of diagnosis of AKI I. We compared patients with a MPP above and below the median value in the first 12 h of diagnosis of AKI. Multivariable logistic regression analyses were performed to identify independent risk factors for progression to AKI III, to explore the impact of MAP and CVP separately, and to investigate the impact of MPP in pre-defined sub-groups.ResultsAmong 2118 ICU patients, 790 patients (37%) developed AKI I of whom 205 underwent advanced haemodynamic monitoring within 12 h of AKI stage I. Their median MPP was 59 mmHg. AKI I patients with a MPP ≤59 mmHg had a significantly higher risk of progressing to AKI stage III (48.6% versus 34%, respectively; p = 0.0034). This association was stronger in patients with ischemic heart disease, congestive cardiac failure or without pre-existing hypertension and in patients with a MAP <65 mmHg for >1 h. As individual components, a raised CVP was independently associated with progression to AKI stage III but MAP alone was not an independent risk factor for AKI progression.ConclusionMPP <60 mmHg was independently associated with AKI progression. CVP was the key component of MPP.

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Section: Discussionmentioning

confidence: 95%

“…To date, there are no established techniques to evaluate and monitor intrarenal blood flow and renal perfusion pressures directly [17]. There are also no reliable means to predict intrarenal haemodynamics from systemic arterial pressures.…”

Section: Introductionmentioning

confidence: 99%

Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients – A retrospective analysis

2017

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“…Among the bacterial disorders affecting the canine species, pyometra is very common and results in sepsis development in 60% of confirmed cases 3 . Sepsis leads to acute kidney injury (AKI) in approximately 50% of people affected 4,5 and in 12% of dogs, of which less than 14% survive 2,6 .…”

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confidence: 99%

Clinical and ultrasound variables for early diagnosis of septic acute kidney injury in bitches with pyometra

Gasser

Uscátegui

Maronezi

et al. 2020

Sci Rep

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The aetiology of septic acute kidney injury (AKI) is not completely elucidated. Early identification of AKi in septic patients is considered to improve survival rate since it allows rapid treatment onset. We evaluated clinical, haematological, urinary, B-mode, spectral Doppler, and contrast-enhanced ultrasound variables in 20 bitches with pyometra as sepsis models and 12 healthy controls. All animals with pyometra presented some degree of renal damage on histological examination; however, sequential organ failure assessment (SOFA) classified only 40% cases with sepsis. AKI derived from systemic infection was identified in 57% of cases with hypoperfusion and in 22% with inflammation, being an affection of multifactorial origin. Among the evaluated parameters, urinary protein/creatinine ratio >0.15, serum albumin <2.94 mg/dL, time-averaged minimum velocity <21.5 cm/s, renal length/ aorta diameter ratio >5.93, pulsatility index >1.53, haematocrit <45%, time-averaged maximum velocity <45.7 cm/s, haemoglobin <16 g/dL, leukocytes >12.53 × 10 3 /uL, and cortical contrast peak intensity <69%, in the order of accuracy, are significant indicators of septic AKI with an accuracy >80%. thus, AKi is a very prevalent condition in septic patients, derived mainly from changes in renal perfusion and inflammation. Additionally, reviewing the SOFA score parameters is suggested to identify renal failure.

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“…Critical care ultrasound has been widely used to examine patients from head to toe in the ICU [ 1 – 7 ]. Protocolized ultrasound examination is so important that with it the information of multiple organs could be integrated as a full picture to make us understand more about the patient, which is also the unique superiority of critical care ultrasound compared to the other imaging or nonimaging tests [ 8 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

The PIEPEAR Workflow: A Critical Care Ultrasound Based 7-Step Approach as a Standard Procedure to Manage Patients with Acute Cardiorespiratory Compromise, with Two Example Cases Presented

Yin

Wang

et al. 2018

BioMed Research International

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Critical care ultrasound (CCUS) has been widely used as a useful tool to assist clinical judgement. The utilization should be integrated into clinical scenario and interact with other tests. No publication has reported this. We present a CCUS based “7-step approach” workflow—the PIEPEAR Workflow—which we had summarized and integrated our experience in CCUS and clinical practice into, and then we present two cases which we have applied the workflow into as examples. Step one is “problems emerged?” classifying the signs of the deterioration into two aspects: acute circulatory compromise and acute respiratory compromise. Step two is “information clear?” quickly summarizing the patient's medical history by three aspects. Step three is “focused exam launched”: (1) focused exam of the heart by five views: the assessment includes (1) fast and global assessment of the heart (heart glance) to identify cases that need immediate life-saving intervention and (2) assessing the inferior vena cava, right heart, diastolic and systolic function of left heart, and systematic vascular resistance to clarify the hemodynamics. (2) Lung ultrasound exam is performed to clarify the predominant pattern of the lung. Step four is “pathophysiologic changes reported.” The results of the focused ultrasound exam were integrated to conclude the pathophysiologic changes. Step five is “etiology explored” diagnosing the etiology by integrating Step two and Step four and searching for the source of infection, according to the clues extracted from the focused ultrasound exam; additional ultrasound exams or other tests should be applied if needed. Step six is “action” supporting the circulation and respiration sticking to Step four. Treat the etiologies according step five. Step seven is “recheck to adjust.” Repeat focused ultrasound and other tests to assess the response to treatment, adjust the treatment if needed, and confirm or correct the final diagnosis. With two cases as examples presented, we insist that applying CCUS with 7-step approach workflow is easy to follow and has theoretical advantages. The coming research on its value is expected.

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Measurement of kidney perfusion in critically ill Patients

Cited by 15 publications

References 60 publications

Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients – A retrospective analysis

Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients – A retrospective analysis

Clinical and ultrasound variables for early diagnosis of septic acute kidney injury in bitches with pyometra

The PIEPEAR Workflow: A Critical Care Ultrasound Based 7-Step Approach as a Standard Procedure to Manage Patients with Acute Cardiorespiratory Compromise, with Two Example Cases Presented

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