Yael Lichter, Amir Gal Oz, Nimrod Adi, Asaph Nini, Yoel Angel, Andrey Nevo, Daniel Aviram, Itay Moshkovits, Ron Wald, Dekel Stavi, Noam Goder
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MAP levels were categorized into 10 groups of 5 mm Hg (from MAP < 60 mm Hg to MAP > 100 mg Hg), and 656,423 coupled hourly mean MAP and UO measurements were analyzed. Additionally, we compared the UO of individual patients in each MAP group with or without norepinephrine (NE) support or diuretics, as well as in patients with acute kidney injury (AKI).Hourly UO rose incrementally between MAP values of 65-100 mm Hg. Among 2,226 patients treated with NE infusion, mean UO was significantly lower in the MAP less than 60 mm Hg group (53.4 mL/hr; 95% CI, 49.3-57.5) compared with all other groups (p < 0.001), but no differences were found between groups of 75 less than or equal to MAP. Among 2500 patients with AKI, there was a linear increase in average UO from the MAP less than 60 mm Hg group (57.1 mL/hr; 95% CI, 54.2-60.0) to the group with MAP greater than or equal to 100 mm Hg (89.4 mL/hr; 95% CI, 85.7-93.1). When MAP was greater than or equal to 65 mm Hg, we observed a statistically significant trend of increased UO in periods without NE infusion.</p><p><strong>Conclusions: </strong>Our analysis revealed a linear correlation between MAP and UO within the range of 65-100 mm Hg, also observed in the subgroup of patients treated with NE or diuretics and in those with AKI. These findings highlight the importance of tissue perfusion to the maintenance of diuresis and achieving adequate fluid balance in critically ill patients.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 8","pages":"e1141"},"PeriodicalIF":0.0000,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319324/pdf/","citationCount":"0","resultStr":"{\"title\":\"Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients.\",\"authors\":\"Yael Lichter, Amir Gal Oz, Nimrod Adi, Asaph Nini, Yoel Angel, Andrey Nevo, Daniel Aviram, Itay Moshkovits, Ron Wald, Dekel Stavi, Noam Goder\",\"doi\":\"10.1097/CCE.0000000000001141\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Mean arterial pressure (MAP) plays a significant role in regulating tissue perfusion and urine output (UO). The optimal MAP target in critically ill patients remains a subject of debate. We aimed to explore the relationship between MAP and UO.</p><p><strong>Design: </strong>A retrospective observational study.</p><p><strong>Setting: </strong>A general ICU in a tertiary medical center.</p><p><strong>Patients: </strong>All critically ill patients admitted to the ICU for more than 10 hours.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>MAP values and hourly UO were collected in 5,207 patients. MAP levels were categorized into 10 groups of 5 mm Hg (from MAP < 60 mm Hg to MAP > 100 mg Hg), and 656,423 coupled hourly mean MAP and UO measurements were analyzed. Additionally, we compared the UO of individual patients in each MAP group with or without norepinephrine (NE) support or diuretics, as well as in patients with acute kidney injury (AKI).Hourly UO rose incrementally between MAP values of 65-100 mm Hg. Among 2,226 patients treated with NE infusion, mean UO was significantly lower in the MAP less than 60 mm Hg group (53.4 mL/hr; 95% CI, 49.3-57.5) compared with all other groups (p < 0.001), but no differences were found between groups of 75 less than or equal to MAP. Among 2500 patients with AKI, there was a linear increase in average UO from the MAP less than 60 mm Hg group (57.1 mL/hr; 95% CI, 54.2-60.0) to the group with MAP greater than or equal to 100 mm Hg (89.4 mL/hr; 95% CI, 85.7-93.1). When MAP was greater than or equal to 65 mm Hg, we observed a statistically significant trend of increased UO in periods without NE infusion.</p><p><strong>Conclusions: </strong>Our analysis revealed a linear correlation between MAP and UO within the range of 65-100 mm Hg, also observed in the subgroup of patients treated with NE or diuretics and in those with AKI. 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引用次数: 0
摘要
目的：平均动脉压（MAP）在调节组织灌注和尿量（UO）方面发挥着重要作用。重症患者的最佳 MAP 目标仍存在争议。我们旨在探讨 MAP 与尿量之间的关系：设计：回顾性观察研究：背景：一家三级医疗中心的普通重症监护室：干预措施：无：测量值和主要结果收集了5207名患者的MAP值和每小时UO值。将 MAP 水平分为 10 组，每组 5 mm Hg（从 MAP < 60 mm Hg 到 MAP > 100 mg Hg），并分析了 656423 个耦合的每小时平均 MAP 和 UO 测量值。此外，我们还比较了各 MAP 组别中使用或不使用去甲肾上腺素（NE）支持或利尿剂的单个患者以及急性肾损伤（AKI）患者的 UO。在接受 NE 输注治疗的 2,226 名患者中，MAP 低于 60 mm Hg 组的平均 UO（53.4 毫升/小时；95% CI，49.3-57.5）明显低于所有其他组（p < 0.001），但 75 低于或等于 MAP 组之间没有发现差异。在 2500 名 AKI 患者中，从 MAP 小于 60 mm Hg 组（57.1 毫升/小时；95% CI，54.2-60.0）到 MAP 大于或等于 100 mm Hg 组（89.4 毫升/小时；95% CI，85.7-93.1），平均 UO 呈线性增长。当 MAP 大于或等于 65 mm Hg 时，我们观察到在不输注 NE 的情况下 UO 有显著的统计学增加趋势：我们的分析表明，在 65-100 mm Hg 范围内，MAP 和 UO 之间存在线性相关，在接受 NE 或利尿剂治疗的亚组患者和有 AKI 的患者中也观察到了这种相关性。这些研究结果突显了组织灌注对重症患者维持利尿和实现适当体液平衡的重要性。
Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients.
Objective: Mean arterial pressure (MAP) plays a significant role in regulating tissue perfusion and urine output (UO). The optimal MAP target in critically ill patients remains a subject of debate. We aimed to explore the relationship between MAP and UO.
Design: A retrospective observational study.
Setting: A general ICU in a tertiary medical center.
Patients: All critically ill patients admitted to the ICU for more than 10 hours.
Interventions: None.
Measurements and main results: MAP values and hourly UO were collected in 5,207 patients. MAP levels were categorized into 10 groups of 5 mm Hg (from MAP < 60 mm Hg to MAP > 100 mg Hg), and 656,423 coupled hourly mean MAP and UO measurements were analyzed. Additionally, we compared the UO of individual patients in each MAP group with or without norepinephrine (NE) support or diuretics, as well as in patients with acute kidney injury (AKI).Hourly UO rose incrementally between MAP values of 65-100 mm Hg. Among 2,226 patients treated with NE infusion, mean UO was significantly lower in the MAP less than 60 mm Hg group (53.4 mL/hr; 95% CI, 49.3-57.5) compared with all other groups (p < 0.001), but no differences were found between groups of 75 less than or equal to MAP. Among 2500 patients with AKI, there was a linear increase in average UO from the MAP less than 60 mm Hg group (57.1 mL/hr; 95% CI, 54.2-60.0) to the group with MAP greater than or equal to 100 mm Hg (89.4 mL/hr; 95% CI, 85.7-93.1). When MAP was greater than or equal to 65 mm Hg, we observed a statistically significant trend of increased UO in periods without NE infusion.
Conclusions: Our analysis revealed a linear correlation between MAP and UO within the range of 65-100 mm Hg, also observed in the subgroup of patients treated with NE or diuretics and in those with AKI. These findings highlight the importance of tissue perfusion to the maintenance of diuresis and achieving adequate fluid balance in critically ill patients.
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