Document Detail

Arterial blood pressure during early sepsis and outcome.
MedLine Citation:
PMID:  19189077     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the association between arterial blood pressure (ABP) during the first 24 h and mortality in sepsis. DESIGN: Retrospective cohort study. SETTING: Multidisciplinary intensive care unit (ICU). PATIENTS AND PARTICIPANTS: A total of 274 septic patients. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: 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 < or = 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. CONCLUSIONS: A MAP level > or = 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.
Martin W Dünser; Jukka Takala; Hanno Ulmer; Viktoria D Mayr; Günter Luckner; Stefan Jochberger; Fritz Daudel; Philipp Lepper; Walter R Hasibeder; Stephan M Jakob
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Publication Detail:
Type:  Journal Article     Date:  2009-02-03
Journal Detail:
Title:  Intensive care medicine     Volume:  35     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-22     Completed Date:  2009-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1225-33     Citation Subset:  IM    
Department of Intensive Care Medicine, Inselspital, 3010, Bern, Switzerland.
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MeSH Terms
Blood Pressure / physiology*
Cohort Studies
Hemodynamics / physiology
Hypotension / diagnosis,  epidemiology
Intensive Care
Intensive Care Units
Middle Aged
ROC Curve
Retrospective Studies
Sepsis / physiopathology*

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