Increasing mean arterial pressure in patients with septic shock: Effects on oxygen variables and renal function*

医学 平均动脉压 心脏指数 血压 感染性休克 血管阻力 心输出量 血流动力学 麻醉 心脏病学 肾功能 去甲肾上腺素 肌酐 内科学 心率 败血症 多巴胺
作者
Aurélie Bourgoin,Marc Léone,Anne Delmas,F. Garnier,J. Albanèse,Claude Martin
出处
期刊:Critical Care Medicine [Lippincott Williams & Wilkins]
卷期号:33 (4): 780-786 被引量:332
标识
DOI:10.1097/01.ccm.0000157788.20591.23
摘要

Objective: To measure the effects of increasing mean arterial pressure on oxygen variables and renal function in septic shock. Design: Prospective, open-label, randomized, controlled study. Setting: Medical-surgical intensive care unit of a tertiary care teaching hospital. Patients: Twenty-eight patients with a diagnosis of septic shock who required fluid resuscitation and pressor agents to increase and maintain mean arterial pressure ≥60 mm Hg. Interventions: Patients were treated with fluid and norepinephrine to achieve and maintain a mean arterial pressure of 65 mm Hg. Then they were randomized in two groups: In the first group (control group, n = 14), mean arterial pressure was maintained at 65 mm Hg, and in the second group (n = 14), mean arterial pressure was increased to 85 mm Hg by increasing the dose of norepinephrine. Measurements and Main Results: Hemodynamic variables (mean arterial pressure, heart rate, mean pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, left and right ventricular stroke indexes), metabolic variables (oxygen delivery, oxygen consumption-calorimetric method, arterial lactate), and renal function variables (urine flow, serum creatinine, creatinine clearance) were measured. After introduction of norepinephrine, similar values of hemodynamic, metabolic, and renal function variables were obtained in both groups. No changes were observed in group 1 during the study period. Increasing mean arterial pressure from 65 to 85 mm Hg with norepinephrine in group 2 resulted in a significant increase in cardiac index from 4.8 (3.8–6.0) to 5.8 (4.3–6.9) L·min−1·m−2. Arterial lactate and oxygen consumption did not change. No changes were observed in renal function variables: urine flow, 63 (14–127) and 70 (15–121) mL; serum creatinine, 170 (117–333) and 153 (112–310) μmol·L−1; and creatinine clearance, 50 (12–77) and 67 (13–89) mL·min−1·1.73 m−2. Conclusions: Increasing mean arterial pressure from 65 to 85 mm Hg with norepinephrine neither affects metabolic variables nor improves renal function.

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