A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study

Jing-Yuan Xu, Si-Qing Ma, Chun Pan, Hong-Li He, Shi-Xia Cai, Shu-Ling Hu, Ai-Ran Liu, Ling Liu, Ying-Zi Huang, Feng-Mei Guo, Yi Yang, Hai-Bo Qiu, Jing-Yuan Xu, Si-Qing Ma, Chun Pan, Hong-Li He, Shi-Xia Cai, Shu-Ling Hu, Ai-Ran Liu, Ling Liu, Ying-Zi Huang, Feng-Mei Guo, Yi Yang, Hai-Bo Qiu

Abstract

Introduction: The effect of mean arterial pressure titration to a higher level on microcirculation in septic shock patients with previous hypertension remains unknown. Our goal is to assess the effect of mean arterial pressure titration to a higher level on microcirculation in hypertensive septic shock patients.

Methods: This is a single-center, open-label study. Hypertensive patients with septic shock for less than 24 hours after adequate fluid resuscitation and requiring norepinephrine to maintain a mean arterial pressure of 65 mmHg were enrolled. Mean arterial pressure was then titrated by norepinephrine from 65 mmHg to the normal level of the patient. In addition to hemodynamic variables, sublingual microcirculation was evaluated by sidestream dark field imaging.

Results: Nineteen patients were enrolled in the study. Increasing mean arterial pressure from 65 mmHg to normal levels was associated with increased central venous pressure (from 11 ± 4 to 13 ± 4 mmHg, P = 0.002), cardiac output (from 5.4 ± 1.4 to 6.4 ± 2.1 l/minute, P = 0.001), and central venous oxygen saturation (from 81 ± 7 to 83 ± 7%, P = 0.001). There were significant increases in small perfused vessel density (from 10.96 ± 2.98 to 11.99 ± 2.55 vessels/mm(2), P = 0.009), proportion of small perfused vessels (from 85 ± 18 to 92 ± 14%, P = 0.002), and small microvascular flow index (from 2.45 ± 0.61 to 2.80 ± 0.68, P = 0.009) when compared with a mean arterial pressure of 65 mmHg.

Conclusions: Increasing mean arterial pressure from 65 mmHg to normal levels is associated with improved microcirculation in hypertensive septic shock patients.

Trial registration: Clinicaltrials.gov: NCT01443494; registered 28 September 2011.

Figures

Figure 1
Figure 1
Baseline and target mean arterial pressure as well as baseline and final norepinephrine doses are displayed. MAP, mean arterial pressure. NE, norepinephrine.
Figure 2
Figure 2
Results of small perfused vessel density are shown as the mean arterial pressure increased from 65 mmHg to usual level with norepinephrine. MAP, mean arterial pressure.
Figure 3
Figure 3
Relationship between the changes in small perfused vessel density, when mean arterial pressure increased from 65 mmHg to usual levels, with the basal small perfused vessel density at a mean arterial pressure of 65 mmHg.
Figure 4
Figure 4
Results of proportion of small perfused vessels are shown as the mean arterial pressure increased from 65 mmHg to usual levels with norepinephrine. MAP, mean arterial pressure.
Figure 5
Figure 5
Results of microvascular flow index are shown as the mean arterial pressure increased from 65 mmHg to usual levels with norepinephrine. MAP, mean arterial pressure.

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