Postoperative blood pressure deficit and acute kidney injury progression in vasopressor-dependent cardiovascular surgery patients - PubMed (original) (raw)

Postoperative blood pressure deficit and acute kidney injury progression in vasopressor-dependent cardiovascular surgery patients

Shinjiro Saito et al. Crit Care. 2016.

Abstract

Background: In vasopressor-dependent patients who had undergone cardiovascular surgery, we examined whether those with progression of acute kidney injury (AKI) had a greater difference (deficit) between premorbid and within-ICU hemodynamic pressure-related parameters compared to those without AKI progression.

Methods: We assessed consecutive adults who underwent cardiovascular surgery and who stayed in our ICU for at least 48 hours and received vasopressor support for more than 4 hours. We obtained premorbid and vasopressor-associated, time-weighted average values for hemodynamic pressure-related parameters (systolic [SAP], diastolic [DAP], and mean arterial pressure [MAP]; central venous pressure [CVP], mean perfusion pressure [MPP], and diastolic perfusion pressure [DPP]) and calculated deficits in those values. We defined AKI progression as an increase of at least one Kidney Disease: Improving Global Outcomes stage.

Results: We screened 159 patients who satisfied the inclusion criteria and identified 76 eligible patients. Thirty-six patients (47%) had AKI progression. All achieved pressure-related values were similar between patients with or without AKI progression. However, deficits in DAP (P = 0.027), MPP (P = 0.023), and DPP (P = 0.002) were significantly greater in patients with AKI progression.

Conclusions: Patients with AKI progression had greater DAP, MPP, and DPP deficits compared to patients without AKI progression. Such deficits might be modifiable risk factors for the prevention of AKI progression.

Keywords: Acute kidney injury; Blood pressure; Blood pressure target; Critical care; Perfusion pressure; Relative hypotension.

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Figures

Fig. 1

Fig. 1

Flow chart of study patients. BP blood pressure, CKD chronic kidney disease, CVP central venous pressure, ECMO extracorporeal membrane oxygenation, IABP intra-aortic balloon pump, ICU intensive care unit, SPP spinal perfusion pressure

Fig. 2

Fig. 2

Comparison of % parameter deficits between patients with progression of AKI (AKI+) and without progression of AKI (AKI–). AKI acute kidney injury, AKI+ increase of at least one KDIGO stage shift, AKI– no KDIGO stage shift, CVP central venous pressure, DAP diastolic arterial pressure, DPP diastolic perfusion pressure, KDIGO Kidney Disease: Improving Global Outcomes, MAP mean arterial pressure, MPP mean perfusion pressure, SAP systolic arterial pressure

Fig. 3

Fig. 3

Hemodynamic deficit change during the first 24 hours of vasopressor support. Diastolic arterial pressure (DAP) deficit, mean perfusion pressure (MPP) deficit, and diastolic perfusion pressure (DPP) deficit for AKI+ (solid lines) and AKI– (dashed lines), respectively. Data are median values. AKI acute kidney injury, AKI+ increase of at least one KDIGO stage shift, AKI– no KDIGO stage shift, KDIGO Kidney Disease: Improving Global Outcomes

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