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Personalizing blood pressure management in septic shock.

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.

journal_name

Ann Intensive Care

journal_title

Annals of intensive care

authors

Kato R,Pinsky MR

doi

10.1186/s13613-015-0085-5

subject

Has Abstract

pub_date

2015-12-01 00:00:00

pages

41

issue

1

issn

2110-5820

pii

10.1186/s13613-015-0085-5

journal_volume

5

pub_type

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