Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial

被引：4

作者：

Fage, Nicolas ^{[1
,2
]}

Demiselle, Julien ^{[3
,4
]}

Seegers, Valerie ^{[5
]}

Merdji, Hamid ^{[3
,4
]}

Grelon, Fabien ^{[6
]}

Megarbane, Bruno ^{[7
]}

Anguel, Nadia ^{[8
]}

Mira, Jean-Paul ^{[9
]}

Dequin, Pierre-Francois ^{[10
]}

Gergaud, Soizic ^{[11
]}

Weiss, Nicolas ^{[12
]}

Legay, Francois ^{[13
]}

Le Tulzo, Yves ^{[14
]}

Conrad, Marie ^{[15
]}

Coudroy, Remi ^{[16
]}

Gonzalez, Frederic ^{[17
]}

Guitton, Christophe ^{[18
]}

Tamion, Fabienne ^{[19
]}

Tonnelier, Jean-Marie ^{[20
]}

Bedos, Jean Pierre ^{[21
]}

Van der Linden, Thierry ^{[22
]}

Vieillard-Baron, Antoine ^{[23
,24
]}

Mariotte, Eric ^{[25
]}

Pradel, Gael ^{[26
]}

Lesieur, Olivier ^{[27
]}

Ricard, Jean-Damien ^{[28
]}

Herve, Fabien ^{[29
]}

Du Cheyron, Damien ^{[30
]}

Guerin, Claude ^{[31
]}

Mercat, Alain ^{[1
]}

Teboul, Jean-Louis ^{[8
]}

Radermacher, Peter ^{[32
]}

Asfar, Pierre ^{[1
]}

机构：

[1] Univ Hosp Angers, Dept Med Intens Care, Angers, France

[2] Univ Angers, MITOVASC Lab UMR INSERM French Natl Inst Hlth & M, CNRS 6015 1083, Angers, France

[3] Univ Hosp Strasbourg, Dept Intens Care Serv Med Intens Reanimat, Nouvel Hop Civil, Strasbourg, France

[4] Univ Strasbourg, INSERM French Natl Inst Hlth & Med Res, FMTS Federat Med Translat Strasbourg, Regenerat Nanomed RNM,UMR 1260, Strasbourg, France

[5] Ctr Paul Papin, Inst Cancerol Ouest, Serv Biometrie, Angers, France

[6] Le Mans Hosp, Med & Surg Intens Care Unit, Le Mans, France

[7] Paris Univ, Lariboisiere Hosp, Dept Med & Toxicol Crit Care, INSERM,UMRS 1144, Paris, France

[8] Paris Saclay Univ, Bicetre Univ Hosp, AP HP, Dept Med Intens Care, Le Kremlin Bicetre, France

[9] Cochin Univ Hosp, Dept Med Intens Care, Paris, France

[10] Tours Univ Hosp, Dept Med Intens Care, Tours, France

[11] Univ Hosp Angers, Dept Surg Intens Care, Angers, France

[12] Univ Paris, Georges Pompidou European Hosp, AP HP, Dept Med Intens Care, Paris, France

[13] St Brieuc Hosp, Med & Surg Intens Care Unit, St Brieuc, France

[14] Rennes Univ Hosp, Dept Infect Dis & Med Intens Care, Rennes, France

[15] Nancy Univ Hosp, Dept Med Intens Care, Nancy, France

[16] Univ Poitiers, Dept Med Intens Care, CHU Poitiers, Poitiers, France

[17] Avicenne Teaching Hosp, Dept Med & Surg Intens Care, Bobigny, France

[18] Nantes Univ Hosp, Dept Med Intens Care, Nantes, France

[19] Rouen Univ Hosp, Dept Med Intens Care, Rouen, France

[20] Brest Univ Hosp, Dept Med Intens Care, Brest, France

[21] Versailles Hosp, Intens Care Unit, Le Chesnay, France

[22] Catholic Univ Lille, Dept Intens Care, St Philibert Hosp, Lille, France

[23] Univ Hosp Ambroise Pare, Dept Med Intens Care, Boulogne Billancourt, France

[24] Fac Paris Saclay, Ctr Res Epidemiol & Populat Hlth CESP, INSERM, U1018, Villejuif, France

[25] St Louis Hosp, Dept Intens Care, Paris, France

[26] Avignon Hosp, Dept Intens Care, Avignon, France

[27] La Rochelle St Louis Hosp, Dept Med & Surg Intens Care, La Rochelle, France

[28] Univ Paris, Hop Louis Mourier, AP HP, Med Intens Reanimat,DMU Esprit, Colombes, France

[29] Quimper Hosp, Dept Med & Surg Intens Care, Quimper, France

[30] Caen Univ Hosp, Dept Med Intens Care, Caen, France

[31] Hop Edouard Herriot, Dept Med Intens Care, Lyon, France

[32] Univ Klinikum, Inst Anasthesiol Pathophysiol & Verfahrensentwick, Helmholtzstr 8-1, Ulm, Germany

来源：

ANNALS OF INTENSIVE CARE | 2022年 / 12卷 / 01期

关键词：

Arterial lactate; Lactate clearance; Mean arterial pressure; Microcirculation; Mottling; Septic shock; 28-DAY MORTALITY; ORGAN FAILURE; DEFINITIONS; PERFUSION; SCORE; FLOW;

D O I：

10.1186/s13613-022-01053-1

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock. Methods The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared mottling and lactate time course between the two MAP target groups. We evaluated the patient's outcome according to the presence or absence of mottling. Results We included 747 patients, 374 were assigned to the low-MAP group and 373 to the high-MAP group. There was no difference in mottling and lactate evolution during the first 24 h between the two MAP groups. After adjustment for MAP and confounding factors, the presence of mottling >= 6 h during the first 24 h was associated with a significantly higher risk of death at day 28 and 90. Patients without mottling or with mottling < 6 h and lactate >= 2 mmol/L have a higher probability of survival than those with mottling >= 6 h and lactate < 2 mmol/L. Conclusion Compared with low MAP target, higher MAP target did not alter mottling and lactate course. Mottling lasting for more than 6 h was associated with higher mortality. Compared to arterial lactate, mottling duration appears to be a better marker of mortality.

引用

页数：10

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