Higher mean arterial pressure targets may be preferable for patients with sepsis

1. In this retrospective cohort study, patients with sepsis and high-mean arterial pressure (MAP) management had a significantly lower 30-, 60-, and 100-day mortality than patients with low-MAP management.

Evidence Rating Level: 2 (Good)

Sepsis is a leading cause of death from infection in the world, with nearly 20 million people suffering from severe sepsis every year. Hemodynamic management is essential in the clinical therapy of sepsis and is critical to stabilize vital signs, delay disease progression, and avoid further tissue and organ failure. However, the range of initial Mean Arterial Pressure (MAP) titration for patients with sepsis remains controversial. An inappropriately low initial MAP results in hypoperfusion of tissues and organs, but if MAP is kept at a high level, the dose of vasoactive drugs needs to be high, and the body may suffer from future re-injury. The 2021 international guidelines for the management of sepsis and septic shock set the initial MAP target as 65 mm Hg, and previous research remains controversial. This retrospective study aimed to study the association between different MAP levels and short-term mortality. Data was obtained from the Medical Information Mart for Intensive Care (MIMIC-III) database, covering detailed information on adult patients admitted to Beth Israel Deaconess Medical Center in Massachusetts from 2001 to 2012. Baseline characteristics and outcome data were collected, and to minimize the potential bias of treatment allocation and confounders, COX regression and Propensity Score Matching (PSM) were utilized to adjust the covariates. Overall, 1,301 patients in the low-MAP group (60 – 65 mm Hg) and the high-MAP group were successfully matched and included in the study. With respect to the primary outcomes, the mortality of the high-MAP group at 30, 60, and 100 was lower than that of the permissive low-MAP group (p<.0001). After adjusting for all covariates by propensity score, the association between the high-MAP group and deceased 30-day mortality was confirmed by COX hazard model multivariate analysis (HR = 0.67; 95% CI, 0.6-0.75, p<.001) in sepsis patients. Overall, the findings from this study suggest that 30-, 60-, and 100-day mortality was significantly higher in the permissive low-MAP group when compared with the high-MAP group. This study is limited by its retrospective nature, which does not allow for the control of all covariates. This study is an important addition to the growing body of evidence regarding sepsis and MAP titration, especially considering the prevalence of sepsis around the world.

Click to read the study in BMC Anesthesiology

Image: PD

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