High versus low blood-pressure target in patients with septic shock
Pierre Asfar, Ferhat Meziani, Jean-François Hamel, Fabien Grelon, Bruno Megarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, René Robert, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Pierre Guezennec, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, Damien du Cheyron, Claude Guerin, Alain Mercat, Jean-Louis Teboul, Peter Radermacher, SEPSISPAM Investigators, Xavier Delabranche, Michel Hasselmann, Christine Kummerlen, Olivier Martinet, Achille Kouatchet, Vincent Souday, Marc Pierrot, Nicolas Lerolle, Satar Mortaza, Pierre Bourgoin, Laurence Carlier, Jacques Armel Giquello, Clément Olivier, Chrystelle Gilet, Laure Masson, Marion Guyon, Justine Schwanka, Jérôme Tayoro, Slimane Saci, Dominique Vivier, Adriana Bildea, Patrice Tirot, Frédéric Baud, Nicolas Deye, Isabelle Malissin, Dominique Vidovar, Sebastian Voicu, Jean-Michel Ekherian, Cédric Cleophax, Sébastien Champion, Sébastien Ena, Nicolas Dufour, David Osman, Claire Mayeur, Laurent Camous, Bertrand Texier, Laurent Guerin, Martin Dres, Christian Richard, Julien Charpentier, Denis Garot, Antoine Guillon, Annick Legras, Elodie Masseret, Emmanuelle Mercier, Sigismond Lasocki, Philippe Fesard, Jean Luc Diehl, Vincent Peigne, Iris Pelieu, Magali Savalle, Emmanuel Guerot, Ana Novara, Christophe Faisy, Jean Yves Fagon, Nicolas Barbarot, Arnaud Person, Jérôme Bousser, France Marjot, Anne Courte, Gilbert Guivarch, Loïc Chimot, Sébastien Gibot, Pierre Edouard Bollaert, Jean Pierre Frat, Remi Coudroy, Frank Chemouni, Laurent Nicolet, Christophe Girault, Gaetan Beduneau, Jean Pierre Bedos, Stéphane Legriel, Benjamin Planquette, Caroline Fourdin, Philippe Cabaret, Franck Minacori, Marie Ledein, Cyril Charron, Elie Azoulay, Amélie Seguin, Virginie Lemiale, Laurence Delapierre, Maxime Leloup, Alexandre Herbland, Vincent Labbe, Rusel Leon, Guillaume Halley, Mickaël Moriconi, Alexandre Tonnelier, Jean Luc Frances, Amélie Seguin, Jean Christophe Richard, Frédérique Bayle, Gaël Bourdin, Pierre Asfar, Ferhat Meziani, Jean-François Hamel, Fabien Grelon, Bruno Megarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, René Robert, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Pierre Guezennec, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, Damien du Cheyron, Claude Guerin, Alain Mercat, Jean-Louis Teboul, Peter Radermacher, SEPSISPAM Investigators, Xavier Delabranche, Michel Hasselmann, Christine Kummerlen, Olivier Martinet, Achille Kouatchet, Vincent Souday, Marc Pierrot, Nicolas Lerolle, Satar Mortaza, Pierre Bourgoin, Laurence Carlier, Jacques Armel Giquello, Clément Olivier, Chrystelle Gilet, Laure Masson, Marion Guyon, Justine Schwanka, Jérôme Tayoro, Slimane Saci, Dominique Vivier, Adriana Bildea, Patrice Tirot, Frédéric Baud, Nicolas Deye, Isabelle Malissin, Dominique Vidovar, Sebastian Voicu, Jean-Michel Ekherian, Cédric Cleophax, Sébastien Champion, Sébastien Ena, Nicolas Dufour, David Osman, Claire Mayeur, Laurent Camous, Bertrand Texier, Laurent Guerin, Martin Dres, Christian Richard, Julien Charpentier, Denis Garot, Antoine Guillon, Annick Legras, Elodie Masseret, Emmanuelle Mercier, Sigismond Lasocki, Philippe Fesard, Jean Luc Diehl, Vincent Peigne, Iris Pelieu, Magali Savalle, Emmanuel Guerot, Ana Novara, Christophe Faisy, Jean Yves Fagon, Nicolas Barbarot, Arnaud Person, Jérôme Bousser, France Marjot, Anne Courte, Gilbert Guivarch, Loïc Chimot, Sébastien Gibot, Pierre Edouard Bollaert, Jean Pierre Frat, Remi Coudroy, Frank Chemouni, Laurent Nicolet, Christophe Girault, Gaetan Beduneau, Jean Pierre Bedos, Stéphane Legriel, Benjamin Planquette, Caroline Fourdin, Philippe Cabaret, Franck Minacori, Marie Ledein, Cyril Charron, Elie Azoulay, Amélie Seguin, Virginie Lemiale, Laurence Delapierre, Maxime Leloup, Alexandre Herbland, Vincent Labbe, Rusel Leon, Guillaume Halley, Mickaël Moriconi, Alexandre Tonnelier, Jean Luc Frances, Amélie Seguin, Jean Christophe Richard, Frédérique Bayle, Gaël Bourdin
Abstract
Background: The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown.
Methods: In a multicenter, open-label trial, we randomly assigned 776 patients with septic shock to undergo resuscitation with a mean arterial pressure target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). The primary end point was mortality at day 28.
Results: At 28 days, there was no significant between-group difference in mortality, with deaths reported in 142 of 388 patients in the high-target group (36.6%) and 132 of 388 patients in the low-target group (34.0%) (hazard ratio in the high-target group, 1.07; 95% confidence interval [CI], 0.84 to 1.38; P=0.57). There was also no significant difference in mortality at 90 days, with 170 deaths (43.8%) and 164 deaths (42.3%), respectively (hazard ratio, 1.04; 95% CI, 0.83 to 1.30; P=0.74). The occurrence of serious adverse events did not differ significantly between the two groups (74 events [19.1%] and 69 events [17.8%], respectively; P=0.64). However, the incidence of newly diagnosed atrial fibrillation was higher in the high-target group than in the low-target group. Among patients with chronic hypertension, those in the high-target group required less renal-replacement therapy than did those in the low-target group, but such therapy was not associated with a difference in mortality.
Conclusions: Targeting a mean arterial pressure of 80 to 85 mm Hg, as compared with 65 to 70 mm Hg, in patients with septic shock undergoing resuscitation did not result in significant differences in mortality at either 28 or 90 days. (Funded by the French Ministry of Health; SEPSISPAM ClinicalTrials.gov number, NCT01149278.).
Source: PubMed