This protocol applies to patients with acute kidney injury who are progressing despite first-line general supportive management — specifically where plasma glucose targets were not maintained — and who are presenting with, or at risk of developing, vasomotor shock.
The first-line approach — general supportive management — targets, among other goals, sustained plasma glucose control at 110–149 mg/dl. When this target is not achieved, continued clinical deterioration, including the development of vasomotor shock, warrants a structured next-line intervention.
For AKI patients with vasomotor shock — or at risk of developing it — the next step involves adding a class of circulatory support alongside continued fluid administration. The complete selection, sequencing, and management algorithm are contained in the full protocol.
The protocol targets restoration of hemodynamic and perfusion parameters within 6 hours:
DOI: 10.1159/000339789
We recommend the use of vasopressors in conjunction with fluids in patients with vasomotor shock with, or at risk for, AKI.
The physiologic goals are: i) return of mean arterial blood pressure to ≥65 mm Hg; ii) central venous pressure between 8–12 mm Hg; iii) improvement in blood lactate levels; iv) central venous oxygen saturation (ScvO2) ≥70%; and v) a urine output of ≥0.5 ml/kg/h.
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