Journal
CRITICAL CARE MEDICINE
Volume 47, Issue 8, Pages 1033-1040Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000003795
Keywords
hypertension; intensive care; mean arterial pressure; microcirculation; sepsis; septic shock
Categories
Funding
- Fundacao de Pesquisa do Estado de Sao Paulo-Grant [2012/19051-1]
Ask authors/readers for more resources
Objectives: To assess whether an increase in mean arterial pressure in patients with septic shock and previous systemic arterial hypertension changes microcirculatory and systemic hemodynamic variables compared with patients without arterial hypertension (control). Design: Prospective, nonblinded, interventional study. Setting: Three ICUs in two teaching hospitals. Patients: After informed consent, we included patients older than 18 years with septic shock for at least 6 hours, sedated, and under mechanical ventilation. We paired patients with and without arterial hypertension by age. Interventions: After obtaining systemic and microcirculation baseline hemodynamic variables (time 0), we increased noradrenaline dose to elevate mean arterial pressure up to 85-90 mm Hg before collecting a new set of measurements (time 1). Measurements and Main Results: We included 40 patients (20 in each group). There was no significant difference in age between the groups. After the rise in mean arterial pressure, there was a significant increase in cardiac index and a slight but significant reduction in lactate in both groups. We observed a significant improvement in the proportion of perfused vessels (control: 57.2 +/- 14% to 66 +/- 14.8%; arterial hypertension: 61.4 +/- 12.3% to 70.8 +/- 7.1%; groups: p = 0.29; T0 and T1: p < 0.001; group and time interaction: p = 0.85); perfused vessels density (control: 15.6 +/- 4 mm/mm(2) to 18.6 +/- 4.5 mm/mm(2); arterial hypertension: 16.4 +/- 3.5 mm/mm(2) to 19.1 +/- 3 mm/mm(2); groups: p = 0.51; T0 and T1: p < 0.001; group and time interaction: p = 0.70), and microcirculatory flow index (control: 2.1 +/- 0.6 to 2.4 +/- 0.6; arterial hypertension: 2.1 +/- 0.5 to 2.6 +/- 0.2; groups: p = 0.71; T0 and T1: p = 0.002; group and time interaction: p = 0.45) in both groups. Conclusions: Increasing mean arterial pressure with noradrenaline in septic shock patients improves density and flow in small vessels of sublingual microcirculation. However, this improvement occurs both in patients with previous arterial hypertension and in those without arterial hypertension.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available