Defining the adequate arterial pressure target during septic shock: not a 'micro' issue but the microcirculation can help
1 AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, Service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270 France
2 Univ Paris-Sud, Faculté de médecine Paris-Sud, EA 4046, 63, rue Gabriel Péri, Le Kremlin-Bicêtre, F-94270 France Le Kremlin-Bicêtre, F-94270 France
Critical Care 2011, 15:1004 doi:10.1186/cc10486
See related research by Throoft et al., http://ccforum.com/content/15/5/R222Published: 2 November 2011
The Surviving Sepsis Campaign guidelines suggest targeting a mean arterial pressure of at least 65 mm Hg to maintain organ perfusion pressure during septic shock. However, the optimal mean arterial pressure can be higher in patients with a history of hypertension or other vascular comorbidities or in those with increased abdominal pressure. In a given individual, the adequate mean arterial pressure target can be difficult to define with the routine hemodynamic parameters (for example, cardiac output, central or mixed venous blood oxygen saturation, and urine output). Near-infrared spectroscopy and sidestream dark field imaging have emerged as promising technologies for monitoring the microcirculation at the bedside. These new methods could provide additional clues to help define the adequate blood pressure to target during the resuscitation phase of septic shock.