Evaluating Renal Resistive Index Responsiveness to MAP Targets in Early Septic Shock: Clinical Implications and Physiologic Insights

Highlight

• Guidelines currently recommend a mean arterial pressure (MAP) ≥65 mm Hg in septic shock, but individualized MAP targets are advocated to optimize renal outcomes.
• The renal resistive index (RRI), assessed via Doppler ultrasound, reflects renal vascular resistance and is linked with acute kidney injury risk.
• This prospective randomized study tested whether early RRI responsiveness to transient MAP elevation could identify patients who benefit from higher MAP targets regarding renal function.
• Patients exhibiting a decrease in RRI with increased MAP did not experience improved kidney outcomes at higher MAP targets, whereas nonresponders showed increased urine output with high MAP, suggesting distinct hemodynamic-renal coupling phenotypes.

Study Background