Noradrenalin as a pArt of the Renal Rescue Protocol

Overview

The acute renal failure (ARF) remains still a serious problem with a high mortality rate in the ICU. All known approaches have failed in the attemptto prevent or treat ARF. Critically ill patients have impaired or absent autoregulation of renal blood flow. The renal blood flow depends in this caseon a mean arterial pressure (MAP). In this way we can influence the course of ARF. In our work we used a modificated approach to ARF, fromCordingey and Palazzo. Our approach contained:1. Reachment of optimal and sometimes of maximal effective intravascular circulating volume.2. Sustain or increase diuresis with continual infusion of diuretics.3. Sustain adequate MAP with continual infusion of noradrenalin.We applicated this approach 19 times with 18 pacients. 18 times we were able to increase diuresis. And this was satisfied to recover renal functionin the group of 12 patients whom two organ systems have failed. Only one patient from this group died. On the other hand the same approach wassatisfied to recover renal function only from one patient in the group of 6 patients where 3 and more organ systems have failed. The other 5 patientsfrom this group required CVVH, CVVHD or HD in the next course of disease. All these 5 patients died.

Key words:
renal failure O mortality O infusion of noradrenadin