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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2019

Open Access 01-12-2019 | Septic Shock | Research

Effects of mean arterial pressure on arousal in sedated ventilated patients with septic shock: a SEPSISPAM post hoc exploratory study

Authors: Youenn Jouan, Valérie Seegers, Ferhat Meziani, Fabien Grelon, Bruno Megarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, René Robert, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Pierre Guezennec, Thierry Van Der Linden, Antoine Vieillard-Baron, Peter Radermacher, Pierre Asfar

Published in: Annals of Intensive Care | Issue 1/2019

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Abstract

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.
Appendix
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Metadata
Title
Effects of mean arterial pressure on arousal in sedated ventilated patients with septic shock: a SEPSISPAM post hoc exploratory study
Authors
Youenn Jouan
Valérie Seegers
Ferhat Meziani
Fabien Grelon
Bruno Megarbane
Nadia Anguel
Jean-Paul Mira
Pierre-François Dequin
Soizic Gergaud
Nicolas Weiss
François Legay
Yves Le Tulzo
Marie Conrad
René Robert
Frédéric Gonzalez
Christophe Guitton
Fabienne Tamion
Jean-Marie Tonnelier
Pierre Guezennec
Thierry Van Der Linden
Antoine Vieillard-Baron
Peter Radermacher
Pierre Asfar
Publication date
01-12-2019
Publisher
Springer International Publishing
Keyword
Septic Shock
Published in
Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-019-0528-5

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