Study of Higher Mean Arterial Pressure Targets to Improve Kidney Function in Adults with Shock and High Central Venous Pressure

What this Trial Is About

Researchers are evaluating the effect of increasing mean arterial pressure MAP on kidney function in adults with shock who also have high central venous pressure CVP. The study aims to determine if raising MAP above the current standard target can better prevent acute kidney problems by improving renal perfusion pressure, which is the difference between MAP and CVP. This is a pilot interventional trial focusing on patients with elevated CVP of 12 cmH2O or higher who require catecholamine treatment for low blood pressure. Participants will undergo two consecutive 6-hour treatment periods with different MAP targets. One period targets a MAP of 65-70 mmHg, and the other targets a higher MAP of 80-85 mmHg. Patients are randomly assigned to the order of these targets. The treatment to achieve these MAP goals includes increasing catecholamines andor fluid volume, guided by the clinician following standard recommendations. The study includes monitoring cardiac output using PICCO or Swan Ganz devices. During the study, kidney function will be assessed by measuring creatinine clearance at the end of each 6-hour period. Additional evaluations include renal resistive index, cardiac function measures, fluid amounts, medication doses, and other laboratory tests at set intervals. Researchers will also record adverse events and monitor clinical outcomes up to 90 days, including survival and duration of intensive care or hospital stay. The total participation involves close monitoring over 12 hours with follow-up data collected at 90 days.

Effects of Increasing Mean Arterial Pressure on Renal Function in Patients With Shock and With Elevated Central Venous Pressure