High versus low blood pressure target in patients with septic shock

High versus low blood pressure target in patients with septic shock. New Eng J Med 2014; 370:1583-93.

Asfar, P., et al.

http://www.nejm.org/doi/full/10.1056/NEJMoa1312173

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.

The highs and lows of blood pressure

The highs and lows of blood pressure: toward meaningful clinical targets in patients with shock. Critical Care Medicine, May 2014, Vol. 42(5), p.1241-51.

Magder, S.A.

http://journals.lww.com/ccmjournal/Abstract/2014/05000/The_Highs_and_Lows_of_Blood_Pressure__Toward.26.aspx

Measurement of blood pressure is fundamental for the management of patients in shock, yet the physiological basis and meaning of blood pressure measurements are complex and often not well understood. This article is in two parts: part 1 deals with the mechanical and physiological aspects of blood pressure and its measurement and part 2 deals with the role of changes in regional resistances in the determination of tissue perfusion and bedside approaches to management of shock.

Noninvasive monitoring of blood pressure in the critically ill

Noninvasive monitoring of blood pressure in the critically ill: Reliability according to the cuff site (arm, thigh or ankle). Critical care medicine, april 2012, Vol. 40(4), p.1207-1213.

Lakhal, K., et al.

http://journals.lww.com/ccmjournal/Abstract/2012/04000/Noninvasive_monitoring_of_blood_pressure_in_the.22.aspx

In the critically ill, blood pressure measurements mostly rely on automated oscillometric devices pending the intra-arterial catheter insertion or after its removal. If the arms are inaccessible, the cuff is placed at the ankle or the thigh, but this common practice has never been assessed.

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