From cardiac output to peripheric perfusion: the perfusional pathway—a case report

We reported the case of a 75-year-old man, who undergone pulmonary lobectomy and on whom we performed renal doppler ultrasound measuring renal doppler resistive index (RDRI) to detect renal and global hypoperfusion. RDRI turned out be earlier than any other hemodynamic and laboratory parameter routinely reported as marker of hypoperfusion. He developed septic shock and a myocardial infarction. His laboratory test and vital parameters suggested a critical condition, on the other hand the blood gas test showed a normal value of lactate and the central venous oxygen saturation (SvcO2) wasn’t altered. During an episode of hypotension, we performed a cardiopulmonary ultrasound that revealed a condition of fluid responsiveness. His renal (RDRI) was 0.75. After a fluid challenge both vital signs and ultrasound measurement improved as we expected. RDRI also decreased to normal values, suggesting an enhancement of kidney and global perfusion. We may point out that performing renal doppler ultrasound and measuring RDRI could allow to detect renal and global hypoperfusion evidently earlier than any other hemodynamic and laboratory parameter routinely reported as marker of hypoperfusion.