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 DuranteauEmail author



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.


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.


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.


Septic shock Norepinephrine Renal function Renal resistive index Doppler ultrasonography 


  1. 1.
    Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873PubMedCrossRefGoogle Scholar
  2. 2.
    Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C, Tasker R, Vallet B (2005) Year in review in intensive care medicine, 2004. II. Brain injury, hemodynamic monitoring and treatment, pulmonary embolism, gastrointestinal tract, and renal failure. Intensive Care Med 31:177–188PubMedCrossRefGoogle Scholar
  3. 3.
    LeDoux D, Astiz ME, Carpati CM, Rackow EC (2000) Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 28:2729–2732PubMedCrossRefGoogle Scholar
  4. 4.
    Bourgoin A, Leone M, Delmas A, Garnier F, Albanese J, Martin C (2005) Increasing mean arterial pressure in patients with septic shock: effects on oxygen variables and renal function. Crit Care Med 33:780–786PubMedCrossRefGoogle Scholar
  5. 5.
    Lerolle N, Guerot E, Faisy C, Bornstain C, Diehl JL, Fagon JY (2006) Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index. Intensive Care Med 32:1553–1559PubMedCrossRefGoogle Scholar
  6. 6.
    Radermacher J, Mengel M, Ellis S, Stuht S, Hiss M, Schwarz A, Eisenberger U, Burg M, Luft FC, Gwinner W, Haller H (2003) The renal arterial resistance index and renal allograft survival. N Engl J Med 349:115–124PubMedCrossRefGoogle Scholar
  7. 7.
    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655PubMedGoogle Scholar
  8. 8.
    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140PubMedCrossRefGoogle Scholar
  9. 9.
    Michard F, Chemla D, Richard C, Wysocki M, Pinsky MR, Lecarpentier Y, Teboul JL (1999) Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med 159:935–939PubMedGoogle Scholar
  10. 10.
    Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138PubMedGoogle Scholar
  11. 11.
    Mostbeck GH, Zontsich T, Turetschek K (2001) Ultrasound of the kidney: obstruction and medical diseases. Eur Radiol 11:1878–1889PubMedCrossRefGoogle Scholar
  12. 12.
    Tublin ME, Bude RO, Platt JF (2003) The resistive index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol 180:885–892PubMedGoogle Scholar
  13. 13.
    Pourcelot L (1974) Applications cliniques de l'examen Doppler transcutané. In: Peronneau P (ed) Velocimetrie ultrasonore Doppler, INSERM, Paris, pp 213–240Google Scholar
  14. 14.
    Knapp R, Plotzeneder A, Frauscher F, Helweg G, Judmaier W, zur Nedden D, Recheis W, Bartsch G (1995) Variability of Doppler parameters in the healthy kidney: an anatomic-physiologic correlation. J Ultrasound Med 14:427–429PubMedGoogle Scholar
  15. 15.
    Platt JF, Ellis JH, Rubin JM (1991) Examination of native kidneys with duplex Doppler ultrasound. Semin Ultrasound CT MR 12:308–318PubMedGoogle Scholar
  16. 16.
    Platt JF (1992) Duplex Doppler evaluation of native kidney dysfunction: obstructive and nonobstructive disease. AJR Am J Roentgenol 158:1035–1042PubMedGoogle Scholar
  17. 17.
    Rawashdeh YF, Djurhuus JC, Mortensen J, Horlyck A, Frokiaer J (2001) The intrarenal resistive index as a pathophysiological marker of obstructive uropathy. J Urol 165:1397–1404PubMedCrossRefGoogle Scholar
  18. 18.
    Shokeir AA, Abubieh EA, Dawaba M, el-Azab M (2003) Resistive index of the solitary kidney: a clinical study of normal values. J Urol 170:377–379PubMedCrossRefGoogle Scholar
  19. 19.
    Ohta Y, Fujii K, Arima H, Matsumura K, Tsuchihashi T, Tokumoto M, Tsuruya K, Kanai H, Iwase M, Hirakata H, Iida M (2005) Increased renal resistive index in atherosclerosis and diabetic nephropathy assessed by Doppler sonography. J Hypertens 23:1905–1911PubMedCrossRefGoogle Scholar
  20. 20.
    Petersen LJ, Petersen JR, Ladefoged SD, Mehlsen J, Jensen HA (1995) The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure. Nephrol Dial Transplant 10:2060–2064PubMedGoogle Scholar
  21. 21.
    Radermacher J, Ellis S, Haller H (2002) Renal resistance index and progression of renal disease. Hypertension 39:699–703PubMedCrossRefGoogle Scholar
  22. 22.
    Schrier RW, Wang W (2004) Acute renal failure and sepsis. N Engl J Med 351:159–169PubMedCrossRefGoogle Scholar
  23. 23.
    Bellomo R, Giantomasso DD (2001) Noradrenaline and the kidney: friends or foes? Crit Care 5:294–298PubMedCrossRefGoogle Scholar
  24. 24.
    Reisbeck M, Astiz ME (2005) Arterial pressure, vasopressors and septic shock: higher is not necessarily better. Crit Care Med 33:906–907PubMedCrossRefGoogle Scholar
  25. 25.
    Peng ZY, Critchley LA, Fok BS (2005) The effects of increasing doses of noradrenaline on systemic and renal circulations in acute bacteraemic dogs. Intensive Care Med 31:1558–1563PubMedCrossRefGoogle Scholar
  26. 26.
    Zubarev AV (2001) Ultrasound of renal vessels. Eur Radiol 11:1902–1915PubMedCrossRefGoogle Scholar
  27. 27.
    Derchi LE, Leoncini G, Parodi D, Viazzi F, Martinoli C, Ratto E, Vettoretti S, Vaccaro V, Falqui V, Tomolillo C, Deferrari G, Pontremoli R (2005) Mild renal dysfunction and renal vascular resistance in primary hypertension. Am J Hypertens 18:966–971PubMedCrossRefGoogle Scholar
  28. 28.
    Cherry RA, Eachempati SR, Hydo L, Barie PS (2002) Accuracy of short-duration creatinine clearance determinations in predicting 24-hour creatinine clearance in critically ill and injured patients. J Trauma 53:267–271PubMedCrossRefGoogle Scholar

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
    Email author
  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

Personalised recommendations