Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature

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• 作者：Marc Leone (1)
  Pierre Asfar (2)
  Peter Radermacher (3)
  Jean-Louis Vincent (4)
  Claude Martin (1)
  
  1. Service d鈥橝nesth茅sie et de R茅animation ; Chemin des Bourrely ; H么pital Nord ; Assistance Publique-H么pitaux de Marseille ; Aix Marseille Universit茅 ; 13015 ; Marseille ; France
  2. D茅partement de R茅animation M茅dicale et de M茅decine Hyperbare Centre Hospitalier Universitaire Angers ; and Laboratoire de Biologie Neurovasculaire et Mitochondriale Int茅gr茅e ; CNRS UMR 6214 - INSERM U1083 ; Universit茅 Angers ; PRES L鈥橴NAM ; 4 Rue Larrey ; 49100 ; Angers ; France
  3. Institut f眉r An盲sthesiologische Pathophysiologie und Verfahrensentwicklung ; Universit盲tsklinikum ; Albert-Einstein-Allee 23 ; 89081 ; Ulm ; Germany
  4. Department of Intensive Care ; Erasme Hospital ; Universit茅 Libre de Bruxelles ; route de Lennik 808 ; 1070 ; Brussels ; Belgium
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：641 KB
• 参考文献：1. Varpula, M, Tallgren, M, Saukkonen, K, Voipio-Pulkki, LM, Pettil盲, V (2005) Hemodynamic variables related to outcome in septic shock. Intensive Care Med 31: pp. 1066-71 CrossRef
  2. D眉nser, MW, Takala, J, Ulmer, H, Mayr, VD, Luckner, G, Jochberger, S, Daudel, F, Lepper, P, Hasibeder, WR, Jakob, SM (2009) Arterial blood pressure during early sepsis and outcome. Intensive Care Med 35: pp. 1225-33 CrossRef
  3. Dellinger, RP, Levy, MM, Rhodes, A, Annane, D, Gerlach, H, Opal, SM, Sevransky, JE, Sprung, CL, Douglas, IS, Jaeschke, R, Osborn, TM, Nunnally, ME, Townsend, SR, Reinhart, K, Kleinpell, RM, Angus, DC, Deutschman, CS, Machado, FR, Rubenfeld, GD, Webb, SA, Beale, RJ, Vincent, JL, Moreno, R (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41: pp. 580-637 CrossRef
  4. L贸pez, 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: pp. 21-30 CrossRef
  5. Hatib, F, Jansen, JR, Pinsky, MR (1985) Peripheral vascular decoupling in porcine endotoxic shock. J Appl Physiol 111: pp. 853-60 CrossRef
  6. Terborg, C, Schummer, W, Albrecht, M, Reinhart, K, Weiller, C, R枚ther, J (2001) Dysfunction of vasomotor reactivity in severe sepsis and septic shock. Intensive Care Med 27: pp. 1231-4 CrossRef
  7. Alban猫se, J, Leone, M, Garnier, F, Bourgoin, A, Antonini, F, Martin, C (2004) Renal effects of norepinephrine in septic and nonseptic patients. Chest 126: pp. 534-9 CrossRef
  8. Strandgaard, S, Olesen, J, Skinhoj, E, Lassen, NA (1973) Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1: pp. 507-10 CrossRef
  9. Wolff, CB (2007) Normal cardiac output, oxygen delivery and oxygen extraction. Adv Exp Med Biol 599: pp. 169-82 CrossRef
  10. Elbers, PW, Ince, C (2006) Mechanisms of critical illness - classifying microcirculatory flow abnormalities in distributive shock. Crit Care 10: pp. 221 CrossRef
  11. Backer, D, Orbegozo Cortes, D, Donadello, K, Vincent, JL (2014) Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence 5: pp. 73-9 CrossRef
  12. Andrades, M脡, Morina, A, Spasi膰, S, Spasojevi膰, I (2011) Bench-to-bedside review: sepsis - from the redox point of view. Crit Care 15: pp. 230 CrossRef
  13. Leone, M, Blidi, S, Antonini, F, Meyssignac, B, Bordon, S, Garcin, F, Charvet, A, Blasco, V, Alban猫se, J, Martin, C (2009) Oxygen tissue saturation is lower in nonsurvivors than in survivors after early resuscitation of septic shock. Anesthesiology 111: pp. 366-71 CrossRef
  14. Payen, D, Luengo, C, Heyer, L, Resche-Rigon, M, Kerever, S, Damoisel, C, Losser, MR (2009) Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome?. Crit Care 13: pp. S6 CrossRef
  15. D眉nser, MW, Hasibeder, WR (2009) Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. J Intensive Care Med 24: pp. 293-316 CrossRef
  16. Corr锚a, TD, Vuda, M, Takala, J, Djafarzadeh, S, Silva, E, Jakob, SM (2013) Increasing mean arterial blood pressure in sepsis: effects on fluid balance, vasopressor load and renal function. Crit Care 17: pp. R21 CrossRef
  17. Georger, JF, Hamzaoui, O, Chaari, A, Maizel, J, Richard, C, Teboul, JL (2010) Restoring arterial pressure with norepinephrine improves muscle tissue oxygenation assessed by near-infrared spectroscopy in severely hypotensive septic patients. Intensive Care Med 36: pp. 1882-9 CrossRef
  18. LeDoux, D, Astiz, ME, Carpati, CM, Rackow, EC (2000) Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 28: pp. 2729-32 CrossRef
  19. Bourgoin, A, Leone, M, Delmas, A, Garnier, F, Alban猫se, J, Martin, C (2005) Increasing mean arterial pressure in patients with septic shock: effects on oxygen variables and renal function. Crit Care Med 33: pp. 780-6 CrossRef
  20. 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 assessed with Doppler ultrasonography. Intensive Care Med 33: pp. 1557-62 CrossRef
  21. Jhanji, S, Stirling, S, Patel, N, Hinds, CJ, Pearse, RM (2009) The effect of increasing doses of norepinephrine on tissue oxygenation and microvascular flow in patients with septic shock. Crit Care Med 37: pp. 1961-6 CrossRef
  22. Thooft, A, Favory, R, Salgado, DR, Taccone, FS, Donadello, K, Backer, D, Creteur, J, Vincent, JL (2011) Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care 15: pp. R222 CrossRef
  23. Dubin, A, Pozo, MO, Casabella, CA, P谩lizas, F, Murias, G, Moseinco, MC, Kanoore Edul, VS, P谩lizas, F, Estenssoro, E, Ince, C (2009) Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: a prospective study. Crit Care 13: pp. R92 CrossRef
  24. Asfar, P, Meziani, F, Hamel, JF, Grelon, F, Megarbane, B, Anguel, N, Mira, JP, Dequin, PF, Gergaud, S, Weiss, N, Legay, F, Tulzo, Y, Conrad, M, Robert, R, Gonzalez, F, Guitton, C, Tamion, F, Tonnelier, JM, Guezennec, P, Linden, T, Vieillard-Baron, A, Mariotte, E, Pradel, G, Lesieur, O, Ricard, JD, Herv茅, F, Cheyron, D, Guerin, C, Mercat, A, Teboul, JL, Radermacher, P (2014) High versus low blood-pressure target in patients with septic shock. N Engl J Med 370: pp. 1583-93 CrossRef
  25. D眉nser, MW, Ruokonen, E, Pettil盲, V, Ulmer, H, Torgersen, C, Schmittinger, CA, Jakob, S, Takala, J (2009) Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial. Crit Care 13: pp. R181 CrossRef
  26. Badin, J, Boulain, T, Ehrmann, S, Skarzynski, M, Bretagnol, A, Buret, J, Benzekri-Lefevre, D, Mercier, E, Runge, I, Garot, D, Mathonnet, A, Dequin, PF, Perrotin, D (2011) Relation between mean arterial pressure and renal function in the early phase of shock: a prospective, explorative cohort study. Crit Care 15: pp. R135 CrossRef
  27. Poukkanen, M, Wilkman, E, Vaara, ST, Pettil盲, V, Kaukonen, KM, Korhonen, AM, Uusaro, A, Hovilehto, S, Inkinen, O, Laru-Sompa, R, Hautam盲ki, R, Kuitunen, A, Karlsson, S (2013) Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study. Crit Care 17: pp. R295 CrossRef
  28. Rivers, E, Nguyen, B, Havstad, S, Ressler, J, Muzzin, A, Knoblich, B, Peterson, E, Tomlanovich, M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345: pp. 1368-77 CrossRef
  29. Peake, SL, Delaney, A, Bailey, M, Bellomo, R, Cameron, PA, Cooper, DJ, Higgins, AM, Holdgate, A, Howe, BD, Webb, SA, Williams, P (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371: pp. 1496-506 CrossRef
  30. Investigators, PCESS, Yealy, DM, Kellum, JA, Huang, DT, Barnato, AE, Weissfeld, LA, Pike, F, Terndrup, T, Wang, HE, Hou, PC, LoVecchio, F, Filbin, MR, Shapiro, NI, Angus, DC (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370: pp. 1683-93 CrossRef
  31. Leone, M, Ragonnet, B, Alonso, S, Allaouchiche, B, Constantin, JM, Jaber, S, Martin, C, Fabbro-Peray, P, Lefrant, JY (2012) Variable compliance with clinical practice guidelines identified in a 1-day audit at 66 French adult intensive care units. Crit Care Med 40: pp. 3189-95 CrossRef
  32. Waechter, J, Kumar, A, Lapinsky, SE, Marshall, J, Dodek, P, Arabi, Y, Parillo, JE, Dellinger, RP, Garland, A (2014) Interaction between fluids and vasoactive agents on mortality in septic shock: a multicentre, observational study. Crit Care Med 42: pp. 2158-68 CrossRef
  33. Pinsky, MR, Payen, D (2005) Functional hemodynamic monitoring. Crit Care 9: pp. 566-72 CrossRef
  34. Pinsky, MR, Teboul, JL (2005) Assessment of indices of preload and volume responsiveness. Curr Opin Crit Care 11: pp. 235-9 CrossRef
  35. Michard, F, Teboul, JL (2000) Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care 4: pp. 282-9 CrossRef
  36. Taylor, AE, Moore, TM (1999) Capillary fluid exchange. Am J Physiol 277: pp. S203-10
  37. Donati, A, Tibboel, D, Ince, C (2013) Towards integrative physiological monitoring of the critically ill: from cardiovascular to microcirculatory and cellular function monitoring at the bedside. Crit Care 17: pp. S5 CrossRef
  38. Ekbal, NJ, Dyson, A, Black, C, Singer, M (2013) Monitoring tissue perfusion, oxygenation, and metabolism in critically ill patients. Chest 143: pp. 1799-808 CrossRef
  39. Backer, D, Ospina-Tascon, G, Salgado, D, Favory, R, Creteur, J, Vincent, JL (2010) Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med 36: pp. 1813-25 CrossRef
  40. Sakr, Y, Dubois, MJ, Backer, D, Creteur, J, Vincent, JL (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32: pp. 1825-31 CrossRef
  41. Trzeciak, S, McCoy, JV, Phillip Dellinger, R, Arnold, RC, Rizzuto, M, Abate, NL, Shapiro, NI, Parrillo, JE, Hollenberg, SM (2008) Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24聽h in patients with sepsis. Intensive Care Med 34: pp. 2210-7 CrossRef
  42. Cecconi, M, Backer, D, Antonelli, M, Beale, R, Bakker, J, Hofer, C, Jaeschke, R, Mebazaa, A, Pinsky, MR, Teboul, JL, Vincent, JL, Rhodes, A (2014) Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40: pp. 1795-815 CrossRef
  
• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Guidelines recommend that a mean arterial pressure (MAP) value greater than 65聽mm Hg should be the initial blood pressure target in septic shock, but what evidence is there to support this statement? We searched Pubmed and Google Scholar by using the key words 鈥榓rterial pressure鈥? 鈥榮eptic shock鈥? and 鈥榥orepinephrine鈥?and retrieved human studies published between 1 January 2000 and 31 July 2014. We identified seven comparative studies: two randomized clinical trials and five observational studies. The results of the literature review suggest that a MAP target of 65聽mm Hg is usually sufficient in patients with septic shock. However, a MAP of around 75 to 85聽mm Hg may reduce the development of acute kidney injury in patients with chronic arterial hypertension. Because of the high prevalence of chronic arterial hypertension in patients who develop septic shock, this finding is of considerable importance. Future studies should assess interactions between time, fluid volumes administered, and doses of vasopressors.