RecruitingNot ApplicableNCT06234592

The Effect of Vasopressor Therapy on Renal Perfusion in Septic Shock

The Effect of Vasopressor Therapy on Renal Perfusion in Patients With Septic Shock - a Mechanistically Focussed Randomized Control Study

Sponsor

King's College Hospital NHS Trust

Enrollment

45 participants

Start Date

Jan 5, 2024

Study Type

INTERVENTIONAL

Conditions

Acute Kidney Injury Septic Shock

Summary

Acute kidney injury (AKI) is a common complication of septic shock and together these conditions carry a high mortality risk. In septic patients who develop severe AKI renal cortical perfusion is deficient despite normal macrovascular organ blood flow. This intra-renal perfusion abnormality may be amenable to pharmacological manipulation, which may offer mechanistic insight into the pathophysiology of septic AKI. The aim of the current study is to investigate the effects of vasopressin and angiotensin II on renal microcirculatory perfusion in a cohort of patients with septic shock.

Eligibility

Min Age: 18 Years

Inclusion Criteria5

Within 48 hours of intensive care admission
Evidence of suspected or confirmed infection
Sequential Organ Failure (SOFA) score increase of 2 or more (assuming a baseline of 0 if no previous measures)
Requirement for norepinephrine infusion as the sole vasopressor agent in a dose of >0.1mcg/kg/min
Lactate >2mmol/L at any stage prior to randomisation

Exclusion Criteria9

Known intolerance to Sonovue™ contrast medium, vasopressin or angiotensin II
Patients receiving other vasoactive drugs in addition to norepinephrine
Patients with known chronic kidney disease (CKD) stage 4 or 5 (baseline glomerular filtration rate (GFR) <30mls/min)
Patients receiving extra corporal membrane oxygenation (ECMO)
Patients with acute occlusive coronary syndromes requiring intervention
Patients with mesenteric ischaemia
Patients with a history or presence of aortic dissection or abdominal aortic aneurysm
Patients with Raynaud's syndrome or acute vaso-occlusive conditions
Pregnancy