Meyer TM, Morales AJA, Esponda PJG

Language: Spanish
References: 14
Page: 87-92
PDF size: 480.21 Kb.

ABSTRACT

Introduction: hemodynamic management in critically ill patients focuses on maintaining optimal cardiac output and blood pressure. In the context of septic shock, vasopressors are used to achieve this. Renal perfusion is evaluated as a success parameter through diuresis and creatinine clearance, as variations in blood pressure directly impact perfusion once the autoregulation threshold is reached. The VeXus protocol uses Doppler ultrasound to classify venous congestion and predict acute kidney injury. Objective: to compare the baseline renal resistance index measured by ultrasonography upon admission to the intensive care unit (ICU) in patients diagnosed with sepsis and to assess changes in this index with the use of Norepinephrine. Material and methods: descriptive, longitudinal, prospective, single-center study evaluating variations in the renal resistance index using Norepinephrine. Results: in a sample of 42 patients, no significant changes were observed in the index of the dose of norepinephrine, with a correlation of 0.2369033. Conclusions: no changes were observed in the renal resistance index in patients requiring Norepinephrine during their ICU stay.

REFERENCES

1. Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet. 2005; 365 (9457): 417-430

2. Schrier RW, Wang W. Acute renal failure and sepsis. N Engl J Med.2004; 351 (2): 159-169.

3. Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y,Spiegel R et al. Quantifying systemic congestion with point-of-careultrasound: development of the venous excess ultrasound gradingsystem. Ultrasound J. 2020; 12: (1): 16.

4. Deruddre S, Cheisson G, Mazoit JX, Vicaut E, Benhamou D,Duranteau J. Renal arterial resistance in septic shock: effects ofincreasing mean arterial pressure with norepinephrine on the renalresistive index assessed with Doppler ultrasonography. Intensive CareMed. 2007; 33 (9): 1557-1562.

5. Correa TD, Vuda M, Takala J, Djafarzadeh S, Silva E, Jakob SM.Increasing mean arterial blood pressure in sepsis: effects on fluid balance,vasopressor load and renal function. Crit Care. 2013; 17 (1): R21.

6. Dubin A, Pozo MO, Casabella CA, Pálizas F, Murias G, Moseinco MC,et al. Increasing arterial blood pressure with norepinephrine does notimprove microcirculatory blood flow: a prospective study. Crit Care.2009; 13 (3): R92.

7. Darmon M, Schortgen F, Vargas F, Liazydi A, Schlemmer B, Brun-Buisson C et al. Diagnostic accuracy of Doppler renal resistive indexfor reversibility of acute kidney injury in critically ill patients. IntensiveCare Med. 2011; 37 (1): 68-76.

8. Lerolle N, Guérot E, Faisy C, Bornstain C, Diehl JL, Fagon JY. Renalfailure in septic shock: predictive value of Doppler-based renalarterial resistive index. Intensive Care Med. 2006; 32 (10): 1553-1559.

9. Anile A, Ferrario S, Campanello L, Orban MA, Castiglione G. Renalresistive index: a new reversible tool for the early diagnosis andevaluation of organ perfusion in critically ill patients: a case report.Ultrasound J. 2019; 11 (1): 23.

10. Rozemeijer S, Haitsma Mulier JLG, Rottgering JG, Elbers PWG,Spoelstra-de Man AME, Tuinman PR et al. Renal resistive index:response to shock and its determinants in critically ill patients. Shock.2019; 52 (1): 43-51.

11. Di Nicolò P, Granata A. Renal intraparenchymal resistive index: theultrasonographic answer to many clinical questions. J Nephrol. 2019;32 (4): 527-538.

12. Koratala A, Reisinger N. Venous excess Doppler ultrasound for thenephrologist: pearls and pitfalls. Kidney Med. 2022; 4 (7): 100482.

13. Ninet S, Schnell D, Dewitte A, Zeni F, Meziani F, Darmon M.Doppler-based renal resistive index for prediction of renal dysfunctionreversibility: a systematic review and meta-analysis. J Crit Care. 2015;30 (3): 629-635.

14. Dewitte A, Coquin J, Meyssignac B, Joannès-Boyau O, Fleureau C,Roze H et al. Doppler resistive index to reflect regulation of renalvascular tone during sepsis and acute kidney injury. Crit Care. 2012;16 (5): R165.