ANZICS CTG Endorsed Study
Relative hypotension and acute kidney injury in patients with shock: a prospective multicentre cohort study
We aim to investigate the degree of relative hypotension that is inadvertently accepted in routine clinical care and assess its relationship with mortality and morbidity among patients who are managed for shock. The rationale for this study is that targeting a standard BP level for all ICU patients with shock may leave a degree of untreated relative hypotension during vasopressor therapy particularly among those with higher pre-morbid BP. The blood flow in the organs may not be adequately restored in presence of such relative hypotension since vascular autoregulation is usually impaired during critical illness. This may delay recovery or may cause new onset organ dysfunction among shocked ICU patients. Determining the patients’ basal BP, then comparing it to what is achieved during ICU management of shock, and quantifying the BP-deficit between the two as a measure of relative hypotension are the core elements of this proposed study. We aim to assess BP-deficit in patients with shock in routine care across several ICUs in Australia and New Zealand, and determine if it is associated with a higher rate of subsequent acute kidney injury or death. To achieve this we aim to prospectively observe 300 consecutive eligible patients across all participating centres, and assess the degree of untreated relative hypotension during the initial 120 hours of treatment of shock in ICU. We will then assess its relationship with the incidence of significant progression of acute kidney injury, incidence of de novo chronic kidney disease and mortality.
Rakshit Panwar (Chair / Project Manager), Rinaldo Bellomo, Miranda Hardie, Frank van Haren, Nicholas Lanyon, John Myburgh, and Manoj Saxena.
John Hunter Hospital
John Hunter Hospital Charitable Trust $23,809
Royal Brisbane Hospital Research Trust $20,500
Rakshit Panwar (email)