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

Guidelines recommend that a mean arterial pressure (MAP) value greater than 65 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 ‘arterial pressure’, ‘septic shock’, an...

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Autores principales: Leone, Marc, Asfar, Pierre, Radermacher, Peter, Vincent, Jean-Louis, Martin, Claude
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355573/
https://www.ncbi.nlm.nih.gov/pubmed/25888071
http://dx.doi.org/10.1186/s13054-015-0794-z
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author Leone, Marc
Asfar, Pierre
Radermacher, Peter
Vincent, Jean-Louis
Martin, Claude
author_facet Leone, Marc
Asfar, Pierre
Radermacher, Peter
Vincent, Jean-Louis
Martin, Claude
author_sort Leone, Marc
collection PubMed
description Guidelines recommend that a mean arterial pressure (MAP) value greater than 65 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 ‘arterial pressure’, ‘septic shock’, and ‘norepinephrine’ 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 mm Hg is usually sufficient in patients with septic shock. However, a MAP of around 75 to 85 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.
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spelling pubmed-43555732015-03-12 Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature Leone, Marc Asfar, Pierre Radermacher, Peter Vincent, Jean-Louis Martin, Claude Crit Care Review Guidelines recommend that a mean arterial pressure (MAP) value greater than 65 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 ‘arterial pressure’, ‘septic shock’, and ‘norepinephrine’ 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 mm Hg is usually sufficient in patients with septic shock. However, a MAP of around 75 to 85 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. BioMed Central 2015-03-10 2015 /pmc/articles/PMC4355573/ /pubmed/25888071 http://dx.doi.org/10.1186/s13054-015-0794-z Text en © Leone et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Leone, Marc
Asfar, Pierre
Radermacher, Peter
Vincent, Jean-Louis
Martin, Claude
Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature
title Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature
title_full Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature
title_fullStr Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature
title_full_unstemmed Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature
title_short Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature
title_sort optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355573/
https://www.ncbi.nlm.nih.gov/pubmed/25888071
http://dx.doi.org/10.1186/s13054-015-0794-z
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