Does Maintaining a Targeted Abdominal Perfusion Pressure Reduce Renal Damage in Patients with Septic Shock?: A Randomized, Controlled, and Open-label Study

Abstract

Background:Increased intra-abdominal pressure (IAP) in patients admitted to the intensive care unit leads to reduced abdominal perfusion pressure (APP), causing circulatory insufficiency and organ failure.Aims:To investigate the effect of maintaining a targeted APP on renal injury and the effect of increased IAP on the mortality rate in patients with septic shock.Study Design:Randomized, controlled, open-label study.Methods:A total of 72 patients were randomly divided into two groups (MAP65 or APP60). The MAP target for patients in the MAP65 group (n = 36) was 65 mmHg according to the Surviving Sepsis Guidelines. In the APP60 group (n = 36), the target APP was set to > 60 mmHg. The glomerular filtration rate (GFR), inotrope consumption, and IAP were recorded daily. The need for renal replacement therapy, decrease in GFR, and 30- and 90-day mortality rates were compared between the two groups.Results:In both the groups, the IAP was statistically similar (p = 0.458). The decreased in GFR was similar in both groups during the first 2 days. From day 3, there was a more statistically significant rapid decline in GFR in the MAP65 group than in the APP60 group. The GFR p-values on the 3rd, 4th, and 5th days were 0.040, 0.043, and 0.032, respectively. Eight patients (22.2%) in the MAP65 group and three patients (8.3%) in the APP group required renal replacement therapy (p = 0.101). The 30-day mortality rates in the MAP65 and APP60 groups were 61.1%, and 47.7%, respectively (p = 0.237). The 90-day mortality rates in the MAP65 and APP60 groups were 66.7% and 66.7%, respectively (p = 1).Conclusion:Setting an APP target limited the reduction in GFR. The mortality rates were similar in the two groups and there was no difference in the rate of end-stage renal failure between the groups.