by
Youenn Jouan et al: Annals of
Intensive Care20199:54 (2019)
Background
It is unknown whether the recommended mean arterial pressure
(MAP) target of 65 mmHg during initial resuscitation of septic shock is
sufficient to maintain cerebral perfusion. Thus, we tested the hypothesis that
a higher MAP target in patients with septic shock may improve level of arousal.
Methods
We performed a post hoc exploratory analysis of the SEPSISPAM
trial, which assessed the effect of a “high-target” level of MAP
(80–85 mmHg) versus the recommended
“low-target” MAP (65–70 mm Hg) on mortality in patients with septic shock.
Among the 776 patients originally recruited in SEPSISPAM trial, we selected
those who were mechanically ventilated and sedated and with available
evaluation of arousal level assessed by the Richmond Agitation and Sedation
Scale (RASS).
Results
We restricted our analysis to the period in which patients were
treated with vasoactive drugs. Cumulative sedative drugs were assessed daily. A
total of 532 patients were included in this study: 253 (47.6%) in the
low-target group and 279 (52.4%) in the high-target group. Daily cumulative
sedative drugs were similar in both groups. Compared to the low-target group,
minimal and maximal RASS were significantly higher in the high-target group at
day 2, 4 and 5. Furthermore, in order to consider the fact that multiple
measures were done for each patient and to consider the global effect of time
on these measures, we used a mixed linear regression and multivariate models:
we confirmed that maximal RASS values were significantly higher in the high-target
group.
Conclusion
In patients with septic shock who were mechanically ventilated
and sedated, resuscitation with MAP target between 80 and 85 mmHg was
associated with higher arousal level as compared to a MAP target between 65 and
70 mmHg.
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