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Contrast-enhanced ultrasonography to evaluate changes in renal cortical microcirculation induced by noradrenaline: a pilot study.

Schneider AG, Goodwin MD, Schelleman A, Bailey M, Johnson L, Bellomo R - Crit Care (2014)

Bottom Line: Noradrenaline-induced increases in MAP were not associated with a significant change in overall CEUS derived mean perfusion indices (median perfusion index 3056 (interquartile range: 2438 to 6771) arbitrary units (a.u.) at baseline versus 4101 (3067 to 5981) a.u. after MAP increase, P = 0.38).A noradrenaline-induced increase in MAP was not associated with an overall increase in renal cortical perfusion as estimated by CEUS.However, at individual level, such response was heterogeneous and unpredictable suggesting great variability in pressure responsiveness within a cohort with a similar clinical phenotype.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Austin Health, 145 Studley road, Heidelberg, VIC, 3084, Australia. antoine.schneider@chuv.ch.

ABSTRACT

Introduction: We used contrast-enhanced ultrasound (CEUS) to estimate the effect of an increase in mean arterial pressure (MAP) induced by noradrenaline infusion on renal microvascular cortical perfusion in critically ill patients.

Methods: Twelve patients requiring a noradrenaline infusion to maintain a MAP more than 60 mmHg within 48 hours of intensive care unit admission were included in the study. Renal CEUS scans with destruction-replenishment sequences and Sonovue® (Bracco, Milano Italy) as a contrast agent, were performed at baseline (MAP 60 to 65 mmHg) and after a noradrenaline-induced increase in MAP to 80 to 85 mmHg.

Results: There was no adverse effect associated with ultrasound contrast agent administration or increase in noradrenaline infusion rate. Adequate images were obtained in all patients at all study times. To reach the higher MAP target, median noradrenaline infusion rate was increased from 10 to 14 μg/min. Noradrenaline-induced increases in MAP were not associated with a significant change in overall CEUS derived mean perfusion indices (median perfusion index 3056 (interquartile range: 2438 to 6771) arbitrary units (a.u.) at baseline versus 4101 (3067 to 5981) a.u. after MAP increase, P = 0.38). At individual level, however, we observed important heterogeneity in responses (range -51% to +97% changes from baseline).

Conclusions: A noradrenaline-induced increase in MAP was not associated with an overall increase in renal cortical perfusion as estimated by CEUS. However, at individual level, such response was heterogeneous and unpredictable suggesting great variability in pressure responsiveness within a cohort with a similar clinical phenotype.

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Related in: MedlinePlus

Perfusion indices patient per patient. (a) Raw data (arbitrary units). (b) Percentage change from baseline. Grey bars are for patients (Pt) with chronic hypertension (Pt 5, 7 and 10). MAP, mean arterial pressure.
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Fig3: Perfusion indices patient per patient. (a) Raw data (arbitrary units). (b) Percentage change from baseline. Grey bars are for patients (Pt) with chronic hypertension (Pt 5, 7 and 10). MAP, mean arterial pressure.

Mentions: However, at the individual level (Figure 3) large variations were observed. Indeed, >25% increase was observed in four patients (>75% in three) and >25% decrease was observed in one patient. Smaller changes were observed in the seven remaining patients (−19 to +16%).Figure 3


Contrast-enhanced ultrasonography to evaluate changes in renal cortical microcirculation induced by noradrenaline: a pilot study.

Schneider AG, Goodwin MD, Schelleman A, Bailey M, Johnson L, Bellomo R - Crit Care (2014)

Perfusion indices patient per patient. (a) Raw data (arbitrary units). (b) Percentage change from baseline. Grey bars are for patients (Pt) with chronic hypertension (Pt 5, 7 and 10). MAP, mean arterial pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4262130&req=5

Fig3: Perfusion indices patient per patient. (a) Raw data (arbitrary units). (b) Percentage change from baseline. Grey bars are for patients (Pt) with chronic hypertension (Pt 5, 7 and 10). MAP, mean arterial pressure.
Mentions: However, at the individual level (Figure 3) large variations were observed. Indeed, >25% increase was observed in four patients (>75% in three) and >25% decrease was observed in one patient. Smaller changes were observed in the seven remaining patients (−19 to +16%).Figure 3

Bottom Line: Noradrenaline-induced increases in MAP were not associated with a significant change in overall CEUS derived mean perfusion indices (median perfusion index 3056 (interquartile range: 2438 to 6771) arbitrary units (a.u.) at baseline versus 4101 (3067 to 5981) a.u. after MAP increase, P = 0.38).A noradrenaline-induced increase in MAP was not associated with an overall increase in renal cortical perfusion as estimated by CEUS.However, at individual level, such response was heterogeneous and unpredictable suggesting great variability in pressure responsiveness within a cohort with a similar clinical phenotype.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Austin Health, 145 Studley road, Heidelberg, VIC, 3084, Australia. antoine.schneider@chuv.ch.

ABSTRACT

Introduction: We used contrast-enhanced ultrasound (CEUS) to estimate the effect of an increase in mean arterial pressure (MAP) induced by noradrenaline infusion on renal microvascular cortical perfusion in critically ill patients.

Methods: Twelve patients requiring a noradrenaline infusion to maintain a MAP more than 60 mmHg within 48 hours of intensive care unit admission were included in the study. Renal CEUS scans with destruction-replenishment sequences and Sonovue® (Bracco, Milano Italy) as a contrast agent, were performed at baseline (MAP 60 to 65 mmHg) and after a noradrenaline-induced increase in MAP to 80 to 85 mmHg.

Results: There was no adverse effect associated with ultrasound contrast agent administration or increase in noradrenaline infusion rate. Adequate images were obtained in all patients at all study times. To reach the higher MAP target, median noradrenaline infusion rate was increased from 10 to 14 μg/min. Noradrenaline-induced increases in MAP were not associated with a significant change in overall CEUS derived mean perfusion indices (median perfusion index 3056 (interquartile range: 2438 to 6771) arbitrary units (a.u.) at baseline versus 4101 (3067 to 5981) a.u. after MAP increase, P = 0.38). At individual level, however, we observed important heterogeneity in responses (range -51% to +97% changes from baseline).

Conclusions: A noradrenaline-induced increase in MAP was not associated with an overall increase in renal cortical perfusion as estimated by CEUS. However, at individual level, such response was heterogeneous and unpredictable suggesting great variability in pressure responsiveness within a cohort with a similar clinical phenotype.

Show MeSH
Related in: MedlinePlus