The purpose of this study is to assess the effect of a higher mean arterial pressure on renal function for patients with shock and elevated central venous pressure.
Adult patients (≥ 18 years old )
Arterial hypotension requiring the etablishment of catecholamines
Norepinephrine dose ⩾ 0.1µg/kg/min at the inclusion
High central venous pressure ≥ 12mmHg
Anuria
Patient with an emergency indication of renal replacement therapy (severe hyperkalemia, severe metabolical acidosis with pH <7.15, acute pulmonary edema due to fluid overload resulting in severe hypoxemia, serum urea concentration > 40 mmol/l)
Pregnant, lactating or parturient woman
Patient deprived of liberty by judicial or administrative decision
Crossover
increase of mean arterial pressure at 65-70 mmHg
Procedure/SurgeryIncrease of mean arterial pressure at 65-70 mmHg (with catecholamines or volemic expansion at the discretion of the clinician)
increase of mean arterial pressure at 80-85 mmHg
Procedure/SurgeryIncrease of mean arterial pressure at 80-85mmHg (with catecholamines or volemic expansion at the discretion of the clinician).
Changes of creatinine clearance
Creatinine clearance is calculated with the formula UV/P as follow : * U being the urinary creatinine concentration in μmol/l * V the urinary volume expressed in ml per unit time * P the plasmatic creatinine concentration in μmol/l
Changes of renal resistive index
We will assess the changes of the renal resistive index with a low MAP target (65-70mmHg) and with a high MAP target (80-85mmHg). Renal resistive index is measured with the use of doppler sonography and is calculated as follow : (peak systolic velocity - end diastolic velocity / peak systolic velocity) Renal resistive index from 3 waveforms are averaged to arrive at mean RI values for each kidney.
Co-morbidities
We will report rate of pre-existing conditions : ischemic heart disease, chronic heart failure, chronic obstructive pulmonary disease, chronic kidney disease, chronic kidney disease requiring long-term dialysis, liver cirrhosis, diabetes, cancer or autoimmune disease, chronic arterial hypertension.
Arterial hypertension treatment
We will report the anterior use of arterial hypertension treatment.
Introduction time of norepinephrine
Day and hour of norepinephrine introduction.
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