Exploring the Utility of Renal Resistive Index in Critical Care: Insights into ARDS and Cardiac Failure

The renal resistive index (RRI), a doppler ultrasound-derived parameter measuring renal vascular resistance, has emerged as a promising non-invasive tool to evaluate renal haemodynamics in critically ill patients, particularly those with Acute Respiratory Distress Syndrome (ARDS) and heart failure (HF). This review examines the current evidence for RRI measurement in these conditions, exploring its physiological bases, methodology, clinical applications, and limitations. In ARDS, RRI reflects the complex interactions between positive pressure ventilation, hypoxemia, and systemic inflammation, showing a role in predicting acute kidney injury and monitoring response to interventions. In HF, RRI is able to assess venous congestion and cardiorenal interactions, also serving as a prognostic indicator. Many studies have shown RRI’s superiority or complementarity to traditional biomarkers in predicting renal dysfunction, though its interpretation requires consideration of multiple patient-related factors. Key challenges include operator dependency, lack of standardization, and complex interpretation in multi-organ dysfunction. Future research should focus on measurement standardization, development of automated techniques, investigation of novel applications like Intra-Parenchymal Renal Resistive Index Variation, and validation of RRI-guided management strategies. Despite its limitations, RRI represents a valuable tool offering bedside and real-time insights into renal hemodynamics and potential guidance for therapeutical interventions. Further research is needed to fully clarify its clinical potential and address current limitations, particularly in critical care setting involving multiple organ dysfunction.