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A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study

The effect of mean arterial pressure titration to a higher level on microcirculation in septic shock patients with previous hypertension remains unknown. Our goal is to assess the effect of mean arterial pressure titration to a higher level on microcirculation in hypertensive septic shock patients....

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Published in:Critical care (London, England) England), 2015-03, Vol.19 (1), p.130-130, Article 130
Main Authors: Xu, Jing-Yuan, Ma, Si-Qing, Pan, Chun, He, Hong-Li, Cai, Shi-Xia, Hu, Shu-Ling, Liu, Ai-Ran, Liu, Ling, Huang, Ying-Zi, Guo, Feng-Mei, Yang, Yi, Qiu, Hai-Bo
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cites cdi_FETCH-LOGICAL-c564t-a04b9bd11839deac076a5e9cf2ddb7159a6a2cf80501410e9588c080f40d24a53
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container_title Critical care (London, England)
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creator Xu, Jing-Yuan
Ma, Si-Qing
Pan, Chun
He, Hong-Li
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Liu, Ling
Huang, Ying-Zi
Guo, Feng-Mei
Yang, Yi
Qiu, Hai-Bo
description The effect of mean arterial pressure titration to a higher level on microcirculation in septic shock patients with previous hypertension remains unknown. Our goal is to assess the effect of mean arterial pressure titration to a higher level on microcirculation in hypertensive septic shock patients. This is a single-center, open-label study. Hypertensive patients with septic shock for less than 24 hours after adequate fluid resuscitation and requiring norepinephrine to maintain a mean arterial pressure of 65 mmHg were enrolled. Mean arterial pressure was then titrated by norepinephrine from 65 mmHg to the normal level of the patient. In addition to hemodynamic variables, sublingual microcirculation was evaluated by sidestream dark field imaging. Nineteen patients were enrolled in the study. Increasing mean arterial pressure from 65 mmHg to normal levels was associated with increased central venous pressure (from 11 ± 4 to 13 ± 4 mmHg, P = 0.002), cardiac output (from 5.4 ± 1.4 to 6.4 ± 2.1 l/minute, P = 0.001), and central venous oxygen saturation (from 81 ± 7 to 83 ± 7%, P = 0.001). There were significant increases in small perfused vessel density (from 10.96 ± 2.98 to 11.99 ± 2.55 vessels/mm(2), P = 0.009), proportion of small perfused vessels (from 85 ± 18 to 92 ± 14%, P = 0.002), and small microvascular flow index (from 2.45 ± 0.61 to 2.80 ± 0.68, P = 0.009) when compared with a mean arterial pressure of 65 mmHg. Increasing mean arterial pressure from 65 mmHg to normal levels is associated with improved microcirculation in hypertensive septic shock patients. Clinicaltrials.gov: NCT01443494; registered 28 September 2011.
doi_str_mv 10.1186/s13054-015-0866-0
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Our goal is to assess the effect of mean arterial pressure titration to a higher level on microcirculation in hypertensive septic shock patients. This is a single-center, open-label study. Hypertensive patients with septic shock for less than 24 hours after adequate fluid resuscitation and requiring norepinephrine to maintain a mean arterial pressure of 65 mmHg were enrolled. Mean arterial pressure was then titrated by norepinephrine from 65 mmHg to the normal level of the patient. In addition to hemodynamic variables, sublingual microcirculation was evaluated by sidestream dark field imaging. Nineteen patients were enrolled in the study. Increasing mean arterial pressure from 65 mmHg to normal levels was associated with increased central venous pressure (from 11 ± 4 to 13 ± 4 mmHg, P = 0.002), cardiac output (from 5.4 ± 1.4 to 6.4 ± 2.1 l/minute, P = 0.001), and central venous oxygen saturation (from 81 ± 7 to 83 ± 7%, P = 0.001). There were significant increases in small perfused vessel density (from 10.96 ± 2.98 to 11.99 ± 2.55 vessels/mm(2), P = 0.009), proportion of small perfused vessels (from 85 ± 18 to 92 ± 14%, P = 0.002), and small microvascular flow index (from 2.45 ± 0.61 to 2.80 ± 0.68, P = 0.009) when compared with a mean arterial pressure of 65 mmHg. Increasing mean arterial pressure from 65 mmHg to normal levels is associated with improved microcirculation in hypertensive septic shock patients. 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Our goal is to assess the effect of mean arterial pressure titration to a higher level on microcirculation in hypertensive septic shock patients. This is a single-center, open-label study. Hypertensive patients with septic shock for less than 24 hours after adequate fluid resuscitation and requiring norepinephrine to maintain a mean arterial pressure of 65 mmHg were enrolled. Mean arterial pressure was then titrated by norepinephrine from 65 mmHg to the normal level of the patient. In addition to hemodynamic variables, sublingual microcirculation was evaluated by sidestream dark field imaging. Nineteen patients were enrolled in the study. Increasing mean arterial pressure from 65 mmHg to normal levels was associated with increased central venous pressure (from 11 ± 4 to 13 ± 4 mmHg, P = 0.002), cardiac output (from 5.4 ± 1.4 to 6.4 ± 2.1 l/minute, P = 0.001), and central venous oxygen saturation (from 81 ± 7 to 83 ± 7%, P = 0.001). There were significant increases in small perfused vessel density (from 10.96 ± 2.98 to 11.99 ± 2.55 vessels/mm(2), P = 0.009), proportion of small perfused vessels (from 85 ± 18 to 92 ± 14%, P = 0.002), and small microvascular flow index (from 2.45 ± 0.61 to 2.80 ± 0.68, P = 0.009) when compared with a mean arterial pressure of 65 mmHg. Increasing mean arterial pressure from 65 mmHg to normal levels is associated with improved microcirculation in hypertensive septic shock patients. Clinicaltrials.gov: NCT01443494; registered 28 September 2011.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>25887027</pmid><doi>10.1186/s13054-015-0866-0</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record>
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ispartof Critical care (London, England), 2015-03, Vol.19 (1), p.130-130, Article 130
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source Open Access: PubMed Central; Access via ProQuest (Open Access)
subjects Aged
Aged, 80 and over
Analysis
Arterial Pressure - drug effects
Blood pressure
Complications and side effects
Critical care
Female
Fluid Therapy
Hemodynamics - drug effects
Humans
Hypertension
Hypertension - drug therapy
Intensive care
Intensive Care Units
Male
Medical research
Medicine, Experimental
Microcirculation - drug effects
Middle Aged
Mouth Floor - blood supply
Norepinephrine - administration & dosage
Norepinephrine - pharmacology
Prospective Studies
Respiration, Artificial - methods
Sepsis
Septic shock
Shock, Septic - drug therapy
Shock, Septic - physiopathology
Vasoconstrictor Agents - administration & dosage
Vasoconstrictor Agents - pharmacology
Venous pressure
title A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study
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