Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/10578
Title: Vasoactive drugs and acute kidney injury.
Authors: Bellomo, Rinaldo;Wan, Li;May, Clive N
Affiliation: Department of Intensive Care and Medicine, Austin Hospital, Melbourne, Australia. rinaldo.bellomo@austin.org.au
Issue Date: 1-Apr-2008
Citation: Critical Care Medicine; 36(4 Suppl): S179-86
Abstract: The use of norepinephrine, and probably vasopressor therapy in general, in intensive care patients with hypotensive vasodilatation despite fluid resuscitation and evidence of acute kidney injury remains the subject of much debate and controversy. Although there is concern about the use of these drugs, these concerns are unfounded. At this time, the experimental and human data strongly suggest that, in these patients, vasopressor therapy is safe and probably beneficial from a renal, and probably general, point of view. On the basis of currently available evidence, in hypotensive vasodilated patients with acute kidney injury, restoration of blood pressure within autoregulatory values should occur promptly with noradrenaline and be sustained until such vasodilatation dissipates. The additional role of other vasopressors in these situations remains unclear. The addition of vasopressin may be helpful in individual patients, but widespread use is not supported by evidence. Alpha-dose dopamine has no advantages over noradrenaline and is not as reliably effective in restoring blood pressure and urine output. Its widespread use cannot be supported in patients with vasodilatation and acute kidney injury. Other vasopressor drugs such as epinephrine and phenylephrine may be similar in efficacy to noradrenaline. However, experience and available data with their use is vastly less than with noradrenaline. Adrenaline, in addition, is associated with hyperglycemia, hyperlactatemia, acidosis, and hypokalemia. Terlipressin appears useful in patients with acute kidney injury secondary to hepatorenal syndrome. Whether it is superior to noradrenaline in this setting remains uncertain, and more studies are needed before recommendations can be made.
Internal ID Number: 18382191
URI: http://ahro.austin.org.au/austinjspui/handle/1/10578
DOI: 10.1097/CCM.0b013e318169167f
URL: http://www.ncbi.nlm.nih.gov/pubmed/18382191
Type: Journal Article
Subjects: Acute Kidney Injury.complications.drug therapy
Animals
Blood Pressure.drug effects
Critical Care
Glomerular Filtration Rate.drug effects
Humans
Hypotension.drug therapy.etiology
Norepinephrine.administration & dosage.therapeutic use
Renal Circulation.drug effects
Vasoconstrictor Agents.therapeutic use
Vasopressins.administration & dosage.therapeutic use
Appears in Collections:Journal articles

Files in This Item:
There are no files associated with this item.


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.