Effect of a fluid challenge and vasopressors use on renal resistive index in critically ill patients with sepsis and its correlation with other clinical parameters and outcome
Authors List
Dr Alexandr Zubarev, Waikato Hospital, Hamilton, NZ
Professor Ravindranath Tiruvoipati, Frankston Hospital, VIC, Australia
Dr Sachin Gupta, Frankston Hospital, VIC, Australia,
Dr Samuel Johnson, Alfred Hospital, VIC, Australia,
Dr Kavi Haji, Frankston Hospital, VIC, Australia
Background: Renal resistive index (RRI), a derived value from the spectral Doppler imaging of intrarenal arteries, is a non-invasive tool to assess renal perfusion. In patients with sepsis, RRI greater than 0.70 - 0.75 is reportedly associated with the development of AKI and worse outcomes. However, the value of RRI as a clinical tool to guide haemodynamic support in patients with sepsis remains unclear.
Design and methods: A prospective observational study in a single tertiary centre ICU. Our primary objective was to investigate the effect of the haemodynamic intervention (fluid challenge and/or vasopressor therapy) on RRI in septic patients within the first 24 hours of their admission to ICU. The haemodynamic intervention was at the discretion of the treating ICU team. The secondary objective was to investigate the correlation between RRI, and the urine output, creatinine, urea and mean arterial pressure in the first 3 days of admission to ICU.
Results: In 25 patients enrolled in the study the median RRI decreased following the haemodynamic intervention from 0.73 to 0.71. Patients with a significant RRI drop of ³ 0.02 (responders) received 4% albumin more often compared to the non-responders (84.6% cf. 33.3%, p = 0.009). Multivariate correlation analysis showed that RRI values pre and post-intervention and during the following 2 days of ICU admission directly correlated with the corresponding noradrenaline infusion rates (p = 0.024), and urea levels (p = 0.024), and inversely correlated with the mean arterial pressure (p = 0.002), and urine output (p = 0.002).
Conclusion: In patients with sepsis-induced AKI, RRI could be a useful bedside tool for assessing kidney perfusion. Larger studies are needed to confirm our findings and to perhaps determine RRI targets for haemodynamic support in septic patients.
Dr Alexandr Zubarev, Waikato Hospital, Hamilton, NZ
Professor Ravindranath Tiruvoipati, Frankston Hospital, VIC, Australia
Dr Sachin Gupta, Frankston Hospital, VIC, Australia,
Dr Samuel Johnson, Alfred Hospital, VIC, Australia,
Dr Kavi Haji, Frankston Hospital, VIC, Australia
Background: Renal resistive index (RRI), a derived value from the spectral Doppler imaging of intrarenal arteries, is a non-invasive tool to assess renal perfusion. In patients with sepsis, RRI greater than 0.70 - 0.75 is reportedly associated with the development of AKI and worse outcomes. However, the value of RRI as a clinical tool to guide haemodynamic support in patients with sepsis remains unclear.
Design and methods: A prospective observational study in a single tertiary centre ICU. Our primary objective was to investigate the effect of the haemodynamic intervention (fluid challenge and/or vasopressor therapy) on RRI in septic patients within the first 24 hours of their admission to ICU. The haemodynamic intervention was at the discretion of the treating ICU team. The secondary objective was to investigate the correlation between RRI, and the urine output, creatinine, urea and mean arterial pressure in the first 3 days of admission to ICU.
Results: In 25 patients enrolled in the study the median RRI decreased following the haemodynamic intervention from 0.73 to 0.71. Patients with a significant RRI drop of ³ 0.02 (responders) received 4% albumin more often compared to the non-responders (84.6% cf. 33.3%, p = 0.009). Multivariate correlation analysis showed that RRI values pre and post-intervention and during the following 2 days of ICU admission directly correlated with the corresponding noradrenaline infusion rates (p = 0.024), and urea levels (p = 0.024), and inversely correlated with the mean arterial pressure (p = 0.002), and urine output (p = 0.002).
Conclusion: In patients with sepsis-induced AKI, RRI could be a useful bedside tool for assessing kidney perfusion. Larger studies are needed to confirm our findings and to perhaps determine RRI targets for haemodynamic support in septic patients.