|Topic:||22. Non Pulmonary Critical Care / Adult / Clinical Studies / Critical Care (CC)|
|Authors:||B. Varajic, J. Mann, K. Guilkey, A. Persaud, S.P. Furmanek, T.L. Wiemken, R. Cavallazzi, M. Saad; Louisville, KY/US|
There is controversy regarding mean arterial pressure (MAP) goals in patients with hepatorenal syndrome (HRS) in the intensive care unit (ICU), with current literature supporting a goal of ≥10 mmHg above the patient’s baseline MAP. This is sometimes difficult to achieve as the patient’s baseline MAP is not always known. In this study, we aim to better define more precise MAP goals in patients with HRS in the ICU setting. We hypothesized there would be no differences in outcomes with regards to outcomes between the two study arms. Here we present the preliminary results of this trial.
This is a prospective, non-blinded, randomized controlled trial. ICU patients with hepatorenal syndrome underwent block randomization to receive either a target MAP ≥ 85mmHg (control arm) or 65–70 mmHg (study arm). The study was designed to determine if there were significant differences in renal outcomes as measured by urine output and serum creatinine changes and reversal of hepatorenal syndrome based upon targeted MAPs at 96 hours. All subjects received octreotide, midodrine, and albumin per current standards of care. Vasopressors were administered to achieve MAP goals. Urine output, creatinine, and cardiovascular events were recorded for a total of 4 days while subjects were in the ICU.
A total of 17 patients were enrolled, nine in the control arm and eight in the study arm. The primary endpoint of urine output at day 4 minus urine output at day 1 was -290 cc/day in the control group versus 10 cc/day in the study group (p value=0.3833). The mean creatinine difference at day 4 minus day 1 was -0.65 mg/dL in the control arm versus -0.84 mg/dL in the study arm (p value=1). There was no significant difference in mortality (odds ratio = 0.83; 95% CI 0.048 to 15.48; p value=1)
Our study did not show a difference in urine output between day 4 and day 1 in patients with target MAP ≥ 85 mmHg versus 65-70 mmHg. Furthermore, there was no difference in creatinine between day 4 and day 1. Thus, our preliminary findings do not support the current practice of achieving target MAP ≥ 85 mmHg in patients with HRS. However, this is a small preliminary study and our findings should be replicated by further large trials.