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Editorials |

Renal Dose Norepinephrine!

Paul E. Marik, MD, MBBCh, FCCP
Author and Funding Information

Affiliations: Pittsburgh, PA
 ,  Dr. Marik is affiliated with the Department of Critical Care Medicine, University of Pittsburgh Medical Center.

Correspondence to: Paul Marik, MD, MBBCh, FCCP, Professor of Critical Care and Medicine, Department of Critical Care, University of Pittsburgh, 640A Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261; e-mail: maripe@ccm.upmc.edu



Chest. 2004;126(2):335-337. doi:10.1378/chest.126.2.335
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Maintenance of an adequate BP, specifically mean arterial pressure (MAP), is essential for adequate tissue perfusion. When the MAP falls below the autoregulatory range of an organ, blood flow decreases in an almost linear fashion. Decreased blood flow results in tissue ischemia and organ failure. In patients with narrowing of their renal, coronary, or cerebral arteries, and in patients with long-standing hypertension, the fall in organ blood flow will occur at a higher BP. Furthermore, different vascular beds will lose autoregulation at different BP values. The autoregulatory threshold for the mammalian kidney is about 80 mm Hg, while that for the brain is approximately 50 mm Hg. An important goal in the management of critically ill patients is therefore to maintain the MAP above the autoregulatory threshold of the kidney, namely, 80 mm Hg. A higher threshold should be targeted in patients with a history of hypertension and in patients with atherosclerotic vascular disease. In patients who have experienced acute cerebrovascular insults, cerebral autoregulation may be lost, and in such circumstances blood flow is pressure-dependent.1 In such patients, increasing the MAP beyond the cerebral autoregulatory range may improve tissue perfusion and decrease neuronal loss.23

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