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

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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 ( IF 8.1 ) Pub Date : 2022-08-19 , DOI: 10.1186/s13613-022-01053-1
Nicolas Fage _{1,

2} , Julien Demiselle _{3,

4} , Valérie Seegers ₅ , Hamid Merdji _{3,

4} , Fabien Grelon ₆ , Bruno Mégarbane ₇ , Nadia Anguel ₈ , Jean-Paul Mira ₉ , Pierre-François Dequin ₁₀ , Soizic Gergaud ₁₁ , Nicolas Weiss ₁₂ , François Legay ₁₃ , Yves Le Tulzo ₁₄ , Marie Conrad ₁₅ , Remi Coudroy ₁₆ , Frédéric Gonzalez ₁₇ , Christophe Guitton ₁₈ , Fabienne Tamion ₁₉ , Jean-Marie Tonnelier ₂₀ , Jean Pierre Bedos ₂₁ , Thierry Van Der Linden ₂₂ , Antoine Vieillard-Baron _{23,

24} , Eric Mariotte ₂₅ , Gaël Pradel ₂₆ , Olivier Lesieur ₂₇ , Jean-Damien Ricard ₂₈ , Fabien Hervé ₂₉ , Damien Du Cheyron ₃₀ , Claude Guerin ₃₁ , Alain Mercat ₁ , Jean-Louis Teboul ₈ , Peter Radermacher ₃₂ , Pierre Asfar ₁

Affiliation

Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
MITOVASC Laboratory UMR INSERM (French National Institute of Health and Medical Research), 1083 - CNRS 6015, University of Angers, Angers, France.
Department of Intensive Care (Service de Médecine Intensive - Réanimation), Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France.
INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France.
Service de Biométrie, Institut de Cancérologie de L'Ouest, Centre Paul Papin, Angers, France.
Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France.
Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France.
Department of Medical Intensive Care, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France.
Department of Medical Intensive Care, Cochin University Hospital, Paris, France.
Department of Medical Intensive Care, Tours University Hospital, Tours, France.
Department of Surgical Intensive Care, University Hospital of Angers, Angers, France.
Department of Medical Intensive Care, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.
Medical and Surgical Intensive Care Unit, Saint Brieuc Hospital, Saint Brieuc, France.
Department of Infectious Diseases and Medical Intensive Care, Rennes University Hospital, Rennes, France.
Department of Medical Intensive Care, Nancy University Hospital, Nancy, France.
Department of Medical Intensive Care, Université de Poitiers, CHU Poitiers, Poitiers, France.
Department of Medical and Surgical Intensive Care, Avicenne Teaching Hospital, Bobigny, France.
Department of Medical Intensive Care, Nantes University Hospital, Nantes, France.
Department of Medical Intensive Care, Rouen University Hospital, Rouen, France.
Department of Medical Intensive Care, Brest University Hospital, Brest, France.
Intensive Care Unit, Versailles Hospital, Le Chesnay, France.
Department of Intensive Care, Saint Philibert Hospital, Catholic University of Lille, Lille, France.
Department of Medical Intensive Care, University Hospital of Ambroise Paré, Boulogne Billancourt, France.
Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Faculty of Paris Saclay, Villejuif, France.
Department of Intensive Care, Saint Louis Hospital, Paris, France.
Department of Intensive Care, Avignon Hospital, Avignon, France.
Department of Medical and Surgical Intensive Care, La Rochelle Saint Louis Hospital, La Rochelle, France.
Université de Paris, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive Réanimation, Colombes, France.
Department of Medical and Surgical Intensive Care, Quimper Hospital, Quimper, France.
Department of Medical Intensive Care, Caen University Hospital, Caen, France.
Department of Medical Intensive Care, Edouard Herriot Hospital, Lyon, France.
Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, Ulm, Germany.

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.

中文翻译：

平均动脉压目标对感染性休克患者斑块和动脉乳酸正常化的影响：SEPSISPAM 随机试验的事后分析

背景

在感染性休克患者中，平均动脉压 (MAP) 目标对斑点病程的影响仍不确定。在这项 SEPSISPAM 试验的事后分析中，我们调查了低 MAP（65 至 70 mmHg）或高 MAP 目标（80 至 85 mmHg）是否会影响感染性休克患者的斑块和动脉乳酸过程。

方法

从加入后 2 小时到儿茶酚胺断奶，每 2 小时评估一次斑点的存在。我们比较了两个 MAP 目标组之间的斑点和乳酸时间过程。我们根据有无斑点评估了患者的预后。

结果

我们纳入了 747 名患者，其中 374 名被分配到低 MAP 组，373 名被分配到高 MAP 组。在两个 MAP 组之间的前 24 小时内，斑点和乳酸的释放没有差异。在调整 MAP 和混杂因素后，在前 24 小时内出现 ≥ 6 小时的斑块与第 28 天和第 90 天的死亡风险显着增加相关。没有斑块或斑块 < 6 小时且乳酸≥2 mmol/ L 的存活概率高于斑点 ≥ 6 h 和乳酸 < 2 mmol/L 的患者。