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Does Maintaining a Targeted Abdominal Perfusion Pressure Reduce Renal Damage in Patients with Septic Shock?: A

Hüseyin Özkarakaş1, Zeki Tuncel Tekgül1, Murat Arslan1

  • 1Clinic of Intensive Care, University of Health Sciences Türkiye, İzmir Bozyaka Trainig and Research Hospital, İzmir, Türkiye

Balkan Medical Journal
|September 18, 2023
PubMed

Insights

Targeting abdominal perfusion pressure (APP) in intensive care unit patients with septic shock helped preserve kidney function compared to standard mean arterial pressure (MAP) targets. While renal function improved, mortality rates remained similar between groups.

Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Hemodynamics

Background:

  • Increased intra-abdominal pressure (IAP) in ICU patients reduces abdominal perfusion pressure (APP), leading to circulatory insufficiency and organ failure.
  • Septic shock patients are particularly vulnerable to the effects of elevated IAP on organ perfusion.

Purpose of the Study:

  • To evaluate the impact of a targeted APP strategy on renal injury in septic shock patients.
  • To assess the effect of elevated IAP on mortality rates in this patient cohort.

Main Methods:

  • A randomized, controlled, open-label study involving 72 septic shock patients.
  • Patients were assigned to either a mean arterial pressure (MAP) target of 65 mmHg (MAP65 group) or an APP target > 60 mmHg (APP60 group).
  • Glomerular filtration rate (GFR), inotrope use, IAP, need for renal replacement therapy, and 30/90-day mortality were compared.

Main Results:

  • GFR declined significantly slower from day 3 in the APP60 group compared to the MAP65 group (p<0.05).
  • Fewer patients in the APP60 group required renal replacement therapy (8.3% vs 22.2%), though this difference was not statistically significant (p=0.101).
  • 30-day and 90-day mortality rates were similar between the MAP65 and APP60 groups (p>0.05).

Conclusions:

  • Maintaining a targeted APP may help mitigate renal injury in septic shock patients.
  • The study did not find a significant difference in mortality or end-stage renal failure between the targeted APP and MAP groups.
Abstract

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