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Blood Pressure Targets in the Initial Stabilization

  • Julien Demiselle
  • Peter Radermacher
  • Pierre AsfarEmail author
Chapter
  • 1.4k Downloads
Part of the Lessons from the ICU book series (LEICU)

Abstract

Blood pressure target in the initial stabilization of patients with shock is a key point for the clinician. We will focus in this chapter on blood pressure targets in the setting of septic shock.

The aim of this chapter is to understand the physiological rationale and clinical evidence for low pressure threshold, high pressure threshold, and increasing mean arterial pressure. The beneficial and harmful effects of such increase will be discussed. Finally, the prerequisites and the difficulties of an individual approach for blood pressure targes will be discussed.

Keywords

Shock Mean arterial pressure target Autoregulation Vasopressor 

References

  1. 1.
    Finfer SR, Vincent J-L, Vincent J-L, De Backer D. Circulatory shock. N Engl J Med. 2013;369:1726–34.CrossRefGoogle Scholar
  2. 2.
    Johnson PC. Autoregulation of blood flow. Circ Res. 1986;59:483–95.CrossRefPubMedGoogle Scholar
  3. 3.
    Bellomo R, Wan L, May C. Vasoactive drugs and acute kidney injury. Crit Care Med. 2008;36:S179–86.CrossRefPubMedGoogle Scholar
  4. 4.
    Cupples WA, Braam B. Assessment of renal autoregulation. Am J Physiol Renal Physiol. 2007;292:F1105–23.CrossRefPubMedGoogle Scholar
  5. 5.
    Strandgaard S, Olesen J, Skinhoj E, Lassen NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J. 1973;1:507–10.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    De Backer D, Donadello K, Taccone F, Ospina-Tascon G, Salgado D, Vincent J-L. Microcirculatory alterations: potential mechanisms and implications for therapy. Ann Intensive Care. 2011;1:27.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rochwerg B, Hylands M, Møller MH, et al. CCCS-SSAI WikiRecs clinical practice guideline: vasopressor blood pressure targets in critically ill adults with hypotension and vasopressor use in early traumatic shock. Intensive Care Med. 2017;43:1062–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–815.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105–9.CrossRefGoogle Scholar
  10. 10.
    O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:e362–425.CrossRefPubMedGoogle Scholar
  11. 11.
    Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki L-M, Pettilä V. Hemodynamic variables related to outcome in septic shock. Intensive Care Med. 2005;31:1066–71.CrossRefPubMedGoogle Scholar
  12. 12.
    Dünser MW, Takala J, Ulmer H, Mayr VD, Luckner G, Jochberger S, Daudel F, Lepper P, Hasibeder WR, Jakob SM. Arterial blood pressure during early sepsis and outcome. Intensive Care Med. 2009;35:1225–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Dünser MW, Ruokonen E, Pettilä V, Ulmer H, Torgersen C, Schmittinger CA, Jakob S, Takala J. Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial. Crit Care. 2009;13:R181.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Asfar P, Meziani F, Hamel J-F, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370:1583–93.CrossRefPubMedGoogle Scholar
  15. 15.
    Canadian Critical Care Trials Group, Lamontagne F, Meade MO, et al. Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial. Intensive Care Med. 2016;42:542–50.CrossRefGoogle Scholar
  16. 16.
    Badin J, Boulain T, Ehrmann S, et al. Relation between mean arterial pressure and renal function in the early phase of shock: a prospective, explorative cohort study. Crit Care. 2011;15:R135.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Poukkanen M, Wilkman E, Vaara ST, et al. Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study. Crit Care Lond Engl. 2013;17:R295.CrossRefGoogle Scholar
  18. 18.
    Deruddre S, Cheisson G, Mazoit J-X, Vicaut E, Benhamou D, Duranteau J. Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography. Intensive Care Med. 2007;33:1557–62.CrossRefPubMedGoogle Scholar
  19. 19.
    LeDoux D, Astiz ME, Carpati CM, Rackow EC. Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med. 2000;28:2729–32.CrossRefPubMedGoogle Scholar
  20. 20.
    Bourgoin A, Leone M, Delmas A, Garnier F, Albanèse J, Martin C. Increasing mean arterial pressure in patients with septic shock: effects on oxygen variables and renal function*. Crit Care Med. 2005;33:780–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Annane D, Vignon P, Renault A, et al. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet Lond Engl. 2007;370:676–84.CrossRefGoogle Scholar
  22. 22.
    Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358:877–87.CrossRefPubMedGoogle Scholar
  23. 23.
    De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362:779–89.CrossRefGoogle Scholar
  24. 24.
    Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe Sepsis. JAMA. 2011;  https://doi.org/10.1001/jama.2011.1615.
  25. 25.
    Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–77.CrossRefGoogle Scholar
  26. 26.
    The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.CrossRefPubMedCentralGoogle Scholar
  27. 27.
    Lamontagne F, Day AG, Meade MO, et al. Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock. Intensive Care Med. 2018;44:12–21.CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Intensive Care Medicine 2019

Authors and Affiliations

  • Julien Demiselle
    • 1
  • Peter Radermacher
    • 2
  • Pierre Asfar
    • 1
    Email author
  1. 1.Medical Intensive Care DepartmentUniversity Hospital of AngersAngersFrance
  2. 2.Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, UniversitätsklinikumUlmGermany

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