Personalizing blood pressure management in septic shock

This review examines the available evidence for targeting a specific mean arterial pressure (MAP) in sepsis resuscitation. The clinical data suggest that targeting an MAP of 65–70 mmHg in patients with septic shock who do not have chronic hypertension is a reasonable first approximation. Whereas in...

Full description

Saved in:
Bibliographic Details
Published in:Annals of intensive care 2015-11, Vol.5 (1), p.41-41, Article 41
Main Authors: Kato, Ryotaro, Pinsky, Michael R.
Format: Article
Language:English
Subjects:
Anesthesiology
Critical Care Medicine
Emergency Medicine
Intensive
Intensive care
Medicine
Medicine & Public Health
Review
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:This review examines the available evidence for targeting a specific mean arterial pressure (MAP) in sepsis resuscitation. The clinical data suggest that targeting an MAP of 65–70 mmHg in patients with septic shock who do not have chronic hypertension is a reasonable first approximation. Whereas in patients with chronic hypertension, targeting a higher MAP of 80–85 mmHg minimizes renal injury, but it comes with increased risk of arrhythmias. Importantly, MAP alone should not be used as a surrogate of organ perfusion pressure, especially under conditions in which intracranial, intra-abdominal or tissue pressures may be elevated. Organ-specific perfusion pressure targets include 50–70 mmHg for the brain based on trauma brain injury as a surrogate for sepsis, 65 mmHg for renal perfusion and >50 mmHg for hepato-splanchnic flow. Even at the same MAP, organs and regions within organs may have different perfusion pressure and pressure–flow relationships. Thus, once this initial MAP target is achieved, MAP should be titrated up or down based on the measures of organ function and tissue perfusion.
ISSN:2110-5820
2110-5820
DOI:10.1186/s13613-015-0085-5