Title |
Personalizing blood pressure management in septic shock
|
---|---|
Published in |
Annals of Intensive Care, November 2015
|
DOI | 10.1186/s13613-015-0085-5 |
Pubmed ID | |
Authors |
Ryotaro Kato, Michael R. Pinsky |
Abstract |
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. |
X Demographics
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Other | 2 | 10% |
Unknown | 5 | 25% |
Demographic breakdown
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Scientists | 4 | 20% |
Practitioners (doctors, other healthcare professionals) | 3 | 15% |
Mendeley readers
Geographical breakdown
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Student > Master | 19 | 9% |
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Unknown | 42 | 20% |
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