Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Mar 10;19(1):101.
doi: 10.1186/s13054-015-0794-z.

Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature

Marc Leone  1 , Pierre Asfar  2 , Peter Radermacher  3 , Jean-Louis Vincent  4 , Claude Martin  5
Affiliations
Review

Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature

Marc Leone et al. Crit Care. .

Abstract

Guidelines recommend that a mean arterial pressure (MAP) value greater than 65 mm Hg should be the initial blood pressure target in septic shock, but what evidence is there to support this statement? We searched Pubmed and Google Scholar by using the key words 'arterial pressure', 'septic shock', and 'norepinephrine' and retrieved human studies published between 1 January 2000 and 31 July 2014. We identified seven comparative studies: two randomized clinical trials and five observational studies. The results of the literature review suggest that a MAP target of 65 mm Hg is usually sufficient in patients with septic shock. However, a MAP of around 75 to 85 mm Hg may reduce the development of acute kidney injury in patients with chronic arterial hypertension. Because of the high prevalence of chronic arterial hypertension in patients who develop septic shock, this finding is of considerable importance. Future studies should assess interactions between time, fluid volumes administered, and doses of vasopressors.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Organ blood flow and blood pressure relationships in healthy individuals, individuals with chronic hypertension, and patients with septic shock. The third linear relationship is theoretical.
Figure 2
Figure 2
Interactions between mean arterial pressure, central venous pressure, and perfusion pressure.
See this image and copyright information in PMC

Comment in

  • One-size MAP does not fit all.
    Senussi MH. Senussi MH. Crit Care. 2015 May 7;19(1):212. doi: 10.1186/s13054-015-0939-0. Crit Care. 2015. PMID: 25947571 Free PMC article. No abstract available.

References

    1. Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettilä V. Hemodynamic variables related to outcome in septic shock. Intensive Care Med. 2005;31:1066–71. doi: 10.1007/s00134-005-2688-z. - DOI - PubMed
    1. Dünser MW, Takala J, Ulmer H, Mayr VD, Luckner G, Jochberger S, Daudel F, Lepper P, Hasibeder WR, Jakob SM. Arterial blood pressure during early sepsis and outcome. Intensive Care Med. 2009;35:1225–33. doi: 10.1007/s00134-009-1427-2. - DOI - PubMed
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637. doi: 10.1097/CCM.0b013e31827e83af. - DOI - PubMed
    1. López A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D, Silverman MS, Takala J, Donaldson J, Arneson C, Grove G, Grossman S, Grover R. Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med. 2004;32:21–30. doi: 10.1097/01.CCM.0000105581.01815.C6. - DOI - PubMed
    1. Hatib F, Jansen JR, Pinsky MR. Peripheral vascular decoupling in porcine endotoxic shock. J Appl Physiol. 1985;111:853–60. doi: 10.1152/japplphysiol.00066.2011. - DOI - PMC - PubMed