1 Department of Internal Medicine, University of Louisville, USA. Electronic address: firstname.lastname@example.org.
2 Department of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, USA.
3 Department of Infectious Disease, University of Louisville, USA.
There is controversy regarding the mean arterial pressure (MAP) goals that should be targeted in the treatment of hepatorenal syndrome (HRS.) We conducted a study to assess different MAP targets in HRS in the intensive care unit (ICU).
MATERIALS AND METHODS:
This is a prospective randomized controlled pilot trial. ICU patients had target mean arterial pressure (MAP)?≥?85?mmHg (control arm) or 65-70?mmHg (study arm). Urine output and serum creatinine were trended and recorded.
A total of 18 patients were enrolled. The day four urine output in the high and low MAP group was 1194 (SD?=?1249) mL/24?h and 920 (SD?=?812) mL/24?h, respectively. The difference in day four - day one urine output was -689 (SD?=?1684) mL/24?h and 272 (SD?=?582) mL/24?h for the high and low MAP groups. The difference in serum creatinine at day four - day one was -0.54 (SD?=?0.63) mg/dL and?-?0.77 (SD?=?1.14) mg/dL in the high and low MAP groups, respectively.
In this study, we failed to prove non-inferiority between a low and high target MAP in patients with HRS.
This trial was registered with and approved by the University of Louisville Internal Review Board and hospital research review committees (IRB # 14.1190). The trial was registered with ClinicalTrials.gov (ID # NCT02789150).