Arterial blood pressure during early sepsis and outcome

作者：Duenser Martin W; Takala Jukka; Ulmer Hanno; Mayr Viktoria D; Luckner Guenter; Jochberger Stefan; Daudel Fritz; Lepper Philipp; Hasibeder Walter R; Jakob Stephan M

来源：Intensive Care Medicine, 2009, 35(7): 1225-1233.

DOI：10.1007/s00134-009-1427-2

• Hypotension
• Mean arterial blood pressure
• Mean perfusion pressure
• Sepsis

To evaluate the association between arterial blood pressure (ABP) during the first 24 h and mortality in sepsis.
Retrospective cohort study.
Multidisciplinary intensive care unit (ICU).
A total of 274 septic patients.
None.
Hemodynamic, and laboratory parameters were extracted from a PDMS database. The hourly time integral of ABP drops below clinically relevant systolic arterial pressure (SAP), mean arterial pressure (MAP), and mean perfusion pressure (MPP = MAP - central venous pressure) levels was calculated for the first 24 h after ICU admission and compared with 28-day-mortality. Binary and linear regression models (adjusted for SAPS II as a measure of disease severity), and a receiver operating characteristic (ROC) analysis were applied. The areas under the ROC curve were largest for the hourly time integrals of ABP drops below MAP 60 mmHg (0.779 vs. 0.764 for ABP drops below MAP 55 mmHg; P a parts per thousand currency sign 0.01) and MPP 45 mmHg. No association between the hourly time integrals of ABP drops below certain SAP levels and mortality was detected. One or more episodes of MAP < 60 mmHg increased the risk of death by 2.96 (CI 95%, 1.06-10.36, P = 0.04). The area under the ROC curve to predict the need for renal replacement therapy was highest for the hourly time integral of ABP drops below MAP 75 mmHg.
A MAP level a parts per thousand yen 60 mmHg may be as safe as higher MAP levels during the first 24 h of ICU therapy in septic patients. A higher MAP may be required to maintain kidney function.

• 出版日期2009-7
• 单位河北医科大学