Effect of early achievement of physiologic resuscitation goals in septic patients admitted from the ward on the kidneys

Abstract

Purpose: The aim of the study was to evaluate if early achievement of physiologic goals of resuscitation in critically ill septic patients admitted from the ward may prevent acute kidney injury (AKI).

Materials and methods: Patients admitted to the intensive care unit (ICU) with a diagnosis of sepsis were retrospectively identified. Mean arterial pressure greater than 65 mm Hg, central venous pressure greater than 8 mm Hg, and central venous oxygenation greater than 70% achieved within 6 hours after ICU consultation at the ward was considered early achievement. Acute kidney injury was defined by the RIFLE criteria.

Results: Of 85 patients, 29% achieved all goals within 6 hours, 42% had late or no achievement of goals, and 28% had incomplete documentation of goals. Of these, 52% developed AKI. Patients who eventually developed AKI had a significantly higher creatinine level at ICU consultation before resuscitation. Delay in achievement of goals results in a 3.4% creatinine level rise per hour in multivariate analysis (P = .03). The development of AKI was significantly influenced by delayed achievement of physiologic goals on the ICU (P = .02).

Conclusions: Although most of AKI occurred before ICU consultation, early physiologic resuscitation and achievement of hemodynamic goals on the ICU is associated with a decrease in development of AKI of septic patients admitted from the ward.