title: Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature.
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.
authors.affiliation: Service d'Anesthésie et de Réanimation, Chemin des Bourrely, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, 13015, Marseille, France. marc.leone@ap-hm.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.affiliation: Département de Réanimation Médicale et de Médecine Hyperbare Centre Hospitalier Universitaire Angers; and Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214 - INSERM U1083, Université Angers, PRES L'UNAM, 4 Rue Larrey, 49100, Angers, France. PiAsfar@chu-angers.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Asfar
authors.affiliation: Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Albert-Einstein-Allee 23, 89081, Ulm, Germany. peter.radermacher@uni-ulm.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Radermacher
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Service d'Anesthésie et de Réanimation, Chemin des Bourrely, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, 13015, Marseille, France. Claude.martin@ap-hm.fr.
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
mesh_terms: D062186:Arterial Pressure / Q000187:drug effects*; D002082:Butylamines; D003422:Critical Care; D006801:Humans; D009638:Norepinephrine / Q000494:pharmacology / Q000627:therapeutic use*; D010636:Phenols; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D002082:Butylamines; C452340:PD 0084430; D010636:Phenols; D014662:Vasoconstrictor Agents; D009638:Norepinephrine