Abstract
This review examines the available evidence for targeting a specific mean arterial pressure (MAP) in sepsis resuscitation. The clinical data suggest that targeting an MAP of 65–70 mmHg in patients with septic shock who do not have chronic hypertension is a reasonable first approximation. Whereas in patients with chronic hypertension, targeting a higher MAP of 80–85 mmHg minimizes renal injury, but it comes with increased risk of arrhythmias. Importantly, MAP alone should not be used as a surrogate of organ perfusion pressure, especially under conditions in which intracranial, intra-abdominal or tissue pressures may be elevated. Organ-specific perfusion pressure targets include 50–70 mmHg for the brain based on trauma brain injury as a surrogate for sepsis, 65 mmHg for renal perfusion and >50 mmHg for hepato-splanchnic flow. Even at the same MAP, organs and regions within organs may have different perfusion pressure and pressure–flow relationships. Thus, once this initial MAP target is achieved, MAP should be titrated up or down based on the measures of organ function and tissue perfusion.
Highlights
In 1969, Weil and Shubin emphasized the importance of fluid resuscitation followed by cardiovascular support with vasoactive agents for the treatment of shock [1]
We reviewed the existing literatures using both PubMed and Google Scholar search engines for the primary search terms: arterial blood pressure, sepsis, severe sepsis, septic shock, perfusion pressure, critical closing pressure and autoregulation
The available evidence suggests that targeting an mean arterial pressure (MAP) of 65–70 mmHg in a patient with septic shock who does not have chronic hypertension is a reasonable first approximation
Summary
In 1969, Weil and Shubin emphasized the importance of fluid resuscitation followed by cardiovascular support with vasoactive agents for the treatment of shock [1]. The study confirmed that targeting an MAP of 65–70 mmHg in a patient without prior chronic hypertension was a reasonable first approximation. In a patient with a history of chronic hypertension, targeting an MAP of 80–85 mmHg was associated with lower incidences of AKI and the need for renal replacement therapy.
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