Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial - Sorbonne Université
Article Dans Une Revue (Article De Synthèse) Annals of Intensive Care Année : 2022

Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial

Bruno Mégarbane
Jean-Paul Mira
  • Fonction : Auteur
  • PersonId : 928244
Remi Coudroy
  • Fonction : Auteur
Jean Pierre Bedos
  • Fonction : Auteur
Antoine Vieillard-Baron
Eric Mariotte
  • Fonction : Auteur
Gaël Pradel
  • Fonction : Auteur
Olivier Lesieur
  • Fonction : Auteur
Jean-Damien Ricard
  • Fonction : Auteur
Fabien Hervé
  • Fonction : Auteur
Damien Du Cheyron
  • Fonction : Auteur
Claude Guerin
  • Fonction : Auteur
Alain Mercat
  • Fonction : Auteur
Jean-Louis Teboul
  • Fonction : Auteur
Peter Radermacher
  • Fonction : Auteur
Pierre Asfar

Résumé

Background: In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock. Methods: The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared mottling and lactate time course between the two MAP target groups. We evaluated the patient's outcome according to the presence or absence of mottling. Results: We included 747 patients, 374 were assigned to the low-MAP group and 373 to the high-MAP group. There was no difference in mottling and lactate evolution during the first 24 h between the two MAP groups. After adjustment for MAP and confounding factors, the presence of mottling ≥ 6 h during the first 24 h was associated with a significantly higher risk of death at day 28 and 90. Patients without mottling or with mottling < 6 h and lactate ≥ 2 mmol/L have a higher probability of survival than those with mottling ≥ 6 h and lactate < 2 mmol/L. Conclusion: Compared with low MAP target, higher MAP target did not alter mottling and lactate course. Mottling lasting for more than 6 h was associated with higher mortality. Compared to arterial lactate, mottling duration appears to be a better marker of mortality.
Fichier principal
Vignette du fichier
Fage AIC 2022.pdf (1.4 Mo) Télécharger le fichier
Origine Publication financée par une institution

Dates et versions

hal-03980601 , version 1 (02-03-2023)

Identifiants

Citer

Nicolas Fage, Julien Demiselle, Valérie Seegers, Hamid Merdji, Fabien Grelon, et al.. Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial. Annals of Intensive Care, 2022, 12 (1), pp.78. ⟨10.1186/s13613-022-01053-1⟩. ⟨hal-03980601⟩
103 Consultations
59 Téléchargements

Altmetric

Partager

More