Pierre Asfar, M.D., Ph.D., Ferhat Meziani, M.D., Ph.D., Jean-François Hamel, M.D., Fabien Grelon, M.D., Bruno Megarbane, M.D., Ph.D., Nadia Anguel, M.D., Jean-Paul Mira, M.D., Ph.D., Pierre-François Dequin, M.D., Ph.D., Soizic Gergaud, M.D., Nicolas Weiss, M.D., Ph.D., François Legay, M.D.,
In septic shock which is the best MAP target to reduce mortality 65-70mm Hg or 80-85mm Hg?
Multicenter, randomised, open label, controlled trial.
- Age ≥18 years with septic shock refractory to administration of 30 mL/kg NS or colloids or was deemed to have inadequate response on right-heart catheterization, pulse-pressure measurement, SV measurement, or echocardiography
- Sepsis defined by ≥2 SIRS criteria, likely or proven infection, and ≥1 organ with new dysfunction
- If requiring norepinephrine or epinephrine:
- Minimum infusion rate of 0.1 ug/kg/min
- Evaluation for enrollment within six hours of initiation of vasopressor therapy
- Lack of competence and no legal guardian, incarceration, pregnancy, or other legal protection
- No French health system affiliation
- Recent participation in another study
- Recent participation in an interventional study with a primary outcome of mortality
- Investigator’s decision to withhold resuscitation
Randomisation to one of two groups:
- Aim for mean 65-70mm Hg
- Aim for mean 80-85mm Hg
Maps were maintained for up to 5 days
Noradrenaline was the first agent in all but one centre which used adrenaline
Fluids given according to FICS guidelines, defined as non-fluid responsive after 30ml/kg
Diuretics, NSAIDS, IV contrast, and nephrotoxic agents were disallowed.
No significant difference in the 28 and 90 day mortality rate found between targeting higher and lower blood pressure, so it would seem in the septic patient there is no benefit to targeting the higher blood pressure.
However, those patients with hypertension or kidney disease did seem to benefit from targeting the higher blood pressure so it maybe valuable to target the higher BP under these circumstances.
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Originally posted 2014-07-04 13:47:47. Republished by Blog Post Promoter