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CRITICAL CARE AND TRAUMA

Monitoring Renal Oxygen Supply in Critically-Ill Patients Using Urinary Oxygen Tension

Andrea Morelli, MD^*, Monica Rocco, MD^*, Giorgio Conti, MD, Alessandra Orecchioni, MD^*, Roberto Alberto De Blasi, MD^*, Flaminia Coluzzi, MD^*, and Paolo Pietropaoli, MD^*

*Department of Anesthesiology and Intensive Care, University of Rome "La Sapienza"; and Department of Anesthesiology and Intensive Care, Catholic University of Rome, Italy

Address correspondence and reprint requests to Andrea Morelli, Via B. Oriani 2, 00197 Rome, Italy. Address e-mail to andrerommel. morelli{at}libero.it

Critically-ill patients are at risk of developing renal disorders as a consequence of systemic hypoperfusion. Ischemic acute tubular necrosis and resulting acute renal failure are caused by hypotension or therapeutic management. In this study, we tested the change of O₂ availability induced by fenoldopam mesylate using the continuous measurement of urinary oxygen tension (PuO₂), a relatively noninvasive technique that could provide potentially important real-time data regarding renal oxygenation in intensive care unit patients. Fenoldopam was administered at different doses (0.03, 0.06, and 0.09 µg · kg^-1 · min^-1) to 50 stable critically-ill patients. Urine output was collected every hour to assess volume and urinary electrolytes. Heart rate, mean arterial blood pressure, cardiac output, pulmonary artery occlusion pressure, arterial oxygen delivery index, and oxygen consumption index were analyzed after fenoldopam dose modifications and at infusion end. PaO₂ and PuO₂ continuous measurements were obtained through two sensors inserted in the radial artery and in the bladder. After a fenoldopam dose increase, PuO₂ significantly increased (P < 0.05), whereas PaO₂ remained unchanged. During the study, heart rate, mean arterial blood pressure, cardiac output, central venous pressure, pulmonary artery occlusion pressure, arterial oxygen delivery index, and oxygen consumption remained unchanged. Dose-dependent PuO₂ increases, unrelated to indexes of systemic perfusion and cardiac function, demonstrate that fenoldopam affects the balance between renal oxygen supply and demand in stable critically-ill patients.

IMPLICATIONS: Acute renal failure in critically-ill patients is associated with frequent mortality. Prolonged renal hypoperfusion cannot be detected by current systemic hemodynamic indexes. Using continuous measurement of urinary oxygen tension, which could indirectly provide real-time data regarding renal oxygenation, our study showed that fenoldopam increases the ratio between oxygen supply and demand.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999