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01.07.2009 | Original

Arterial blood pressure during early sepsis and outcome

verfasst von: Martin W. Dünser, Jukka Takala, Hanno Ulmer, Viktoria D. Mayr, Günter Luckner, Stefan Jochberger, Fritz Daudel, Philipp Lepper, Walter R. Hasibeder, Stephan M. Jakob

Erschienen in: Intensive Care Medicine | Ausgabe 7/2009

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Abstract

Objective

To evaluate the association between arterial blood pressure (ABP) during the first 24 h and mortality in sepsis.

Design

Retrospective cohort study.

Setting

Multidisciplinary intensive care unit (ICU).

Patients and participants

A total of 274 septic patients.

Interventions

None.

Measurements and results

Hemodynamic, and laboratory parameters were extracted from a PDMS database. The hourly time integral of ABP drops below clinically relevant systolic arterial pressure (SAP), mean arterial pressure (MAP), and mean perfusion pressure (MPP = MAP − central venous pressure) levels was calculated for the first 24 h after ICU admission and compared with 28-day-mortality. Binary and linear regression models (adjusted for SAPS II as a measure of disease severity), and a receiver operating characteristic (ROC) analysis were applied. The areas under the ROC curve were largest for the hourly time integrals of ABP drops below MAP 60 mmHg (0.779 vs. 0.764 for ABP drops below MAP 55 mmHg; P ≤ 0.01) and MPP 45 mmHg. No association between the hourly time integrals of ABP drops below certain SAP levels and mortality was detected. One or more episodes of MAP < 60 mmHg increased the risk of death by 2.96 (CI 95%, 1.06–10.36, P = 0.04). The area under the ROC curve to predict the need for renal replacement therapy was highest for the hourly time integral of ABP drops below MAP 75 mmHg.

Conclusions

A MAP level ≥ 60 mmHg may be as safe as higher MAP levels during the first 24 h of ICU therapy in septic patients. A higher MAP may be required to maintain kidney function.

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Titel: Arterial blood pressure during early sepsis and outcome
verfasst von: Martin W. Dünser
Jukka Takala
Hanno Ulmer
Viktoria D. Mayr
Günter Luckner
Stefan Jochberger
Fritz Daudel
Philipp Lepper
Walter R. Hasibeder
Stephan M. Jakob
Publikationsdatum: 01.07.2009
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 7/2009
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1427-2

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Arterial blood pressure during early sepsis and outcome