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Intensive Care Medicine

, Volume 33, Issue 9, pp 1557–1562 | Cite as

Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography

  • Stéphane Deruddre
  • Gaëlle Cheisson
  • Jean-Xavier Mazoit
  • Eric Vicaut
  • Dan Benhamou
  • Jacques Duranteau
Original

Abstract

Objective

To determine the effects of increasing mean arterial pressure (MAP) on renal resistances assessed by Doppler ultrasonography in septic shock.

Design and setting

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

Patients and participants

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

Interventions

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.

Measurements and 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.

Keywords

Septic shock Norepinephrine Renal function Renal resistive index Doppler ultrasonography 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Stéphane Deruddre
    • 1
  • Gaëlle Cheisson
    • 1
  • Jean-Xavier Mazoit
    • 1
  • Eric Vicaut
    • 2
  • Dan Benhamou
    • 1
  • Jacques Duranteau
    • 1
  1. 1.Département d’Anesthésie-Réanimation, Hôpital Bicêtre, AP-HPUniversité Paris XILe Kremlin-BicêtreFrance
  2. 2.Laboratoire d’Etude de la Microcirculation et Département de Biophysique, Hôpital Lariboisière, AP-HPUniversité Paris VIIParisFrance

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