Abstract
In critical illness, septic shock is a contributing factor in nearly half of all cases of acute kidney injury (AKI). Traditional approaches to prevention of organ dysfunction in early sepsis have focused on prevention of hypoperfusion by optimisation of systemic haemodynamics, primarily by fluid resuscitation. Fluid administration to a target central venous pressure (CVP) of 8 to 12 mmHg (12 to 15 mmHg in mechanically ventilated patients) is currently recommended for the early resuscitation of septic shock. However, in the previous issue of Critical Care, Legrand and colleagues report that higher CVP in the first 24 hours of ICU admission with septic shock was associated with increased risk for development or persistence of AKI over the next 5 days. This study highlights a potential association between venous congestion and the development of septic AKI, suggesting that CVP-targeted fluid resuscitation in septic shock might not be beneficial for renal function.
Highlights
In critical illness, septic shock is a contributing factor in nearly half of all cases of acute kidney injury (AKI)
In the previous issue of Critical Care, Legrand and colleagues examine the association between haemodynamic targets of resuscitation (cardiac output, mean or diastolic blood pressure, central venous pressure (CVP) and central venous oxygen saturation) and development or persistence
The authors found that only higher CVP and low diastolic blood pressure were associated with increased risk of development of new AKI, or persistence of renal dysfunction present at ICU admission
Summary
Septic shock is a contributing factor in nearly half of all cases of acute kidney injury (AKI). In the previous issue of Critical Care, Legrand and colleagues examine the association between haemodynamic targets of resuscitation (cardiac output, mean or diastolic blood pressure, central venous pressure (CVP) and central venous oxygen saturation) and development or persistence
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