Arterial blood pressure during early sepsis and outcome
- 1.7k Downloads
To evaluate the association between arterial blood pressure (ABP) during the first 24 h and mortality in sepsis.
Retrospective cohort study.
Multidisciplinary intensive care unit (ICU).
Patients and participants
A total of 274 septic patients.
Measurements and results
Hemodynamic, and laboratory parameters were extracted from a PDMS database. The hourly time integral of ABP drops below clinically relevant systolic arterial pressure (SAP), mean arterial pressure (MAP), and mean perfusion pressure (MPP = MAP − central venous pressure) levels was calculated for the first 24 h after ICU admission and compared with 28-day-mortality. Binary and linear regression models (adjusted for SAPS II as a measure of disease severity), and a receiver operating characteristic (ROC) analysis were applied. The areas under the ROC curve were largest for the hourly time integrals of ABP drops below MAP 60 mmHg (0.779 vs. 0.764 for ABP drops below MAP 55 mmHg; P ≤ 0.01) and MPP 45 mmHg. No association between the hourly time integrals of ABP drops below certain SAP levels and mortality was detected. One or more episodes of MAP < 60 mmHg increased the risk of death by 2.96 (CI 95%, 1.06–10.36, P = 0.04). The area under the ROC curve to predict the need for renal replacement therapy was highest for the hourly time integral of ABP drops below MAP 75 mmHg.
A MAP level ≥ 60 mmHg may be as safe as higher MAP levels during the first 24 h of ICU therapy in septic patients. A higher MAP may be required to maintain kidney function.
KeywordsHypotension Mean arterial blood pressure Mean perfusion pressure Sepsis
The authors are indebted to Mrs. Pia Burri and Mr. Roy Lanz for their invaluable assistance in extracting the study variables from the database.
- 2.Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596PubMedCrossRefGoogle Scholar
- 8.Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM, Surviving Sepsis Campaign Management Guidelines Committee (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873PubMedCrossRefGoogle Scholar
- 10.Lopez A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D, Silverman MS, Takala J, Donaldson J, Arneson C, Grove G, Grossman S, Grover R (2004) Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 32:21–30PubMedCrossRefGoogle Scholar
- 14.Dünser MW, Daudel F, Luckner G, Mayr V, Jochberger S, Hasibeder WR, Takala J, Jakob S (2007) Arterial blood pressure during early sepsis. Intensive Care Med 33(Suppl 2):A125Google Scholar
- 20.Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the european society of intensive care medicine. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
- 25.Guyton AC, Hall JE (2000) Urine formation by the kidneys: I. Glomerular filtration, renal blood flow, and their control. In: Guyton AC, Hall JE (eds) Textbook of medical physiology. Saunders, Philadelphia, pp 279–294Google Scholar
- 27.Rowell LB (1986) Control of individual vascular beds: splanchnic and renal circulations. In: Rowell LB (ed) Human circulation. Regulation during physical stress. Oxford University Press, Oxford, pp 78–95Google Scholar
- 29.Deruddre S, Cheisson G, Mazoit JX, Vicaut E, Benhamou D, Duranteau J (2007) Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index with Doppler ultrasonography. Intensive Care Med 33:1557–1562PubMedCrossRefGoogle Scholar