title: A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study.
abstract: BACKGROUND
  The effect of mean arterial pressure titration to a higher level on microcirculation in septic shock patients with previous hypertension remains unknown. Our goal is to assess the effect of mean arterial pressure titration to a higher level on microcirculation in hypertensive septic shock patients.
  
  
  METHODS
  This is a single-center, open-label study. Hypertensive patients with septic shock for less than 24 hours after adequate fluid resuscitation and requiring norepinephrine to maintain a mean arterial pressure of 65 mmHg were enrolled. Mean arterial pressure was then titrated by norepinephrine from 65 mmHg to the normal level of the patient. In addition to hemodynamic variables, sublingual microcirculation was evaluated by sidestream dark field imaging.
  
  
  RESULTS
  Nineteen patients were enrolled in the study. Increasing mean arterial pressure from 65 mmHg to normal levels was associated with increased central venous pressure (from 11 ± 4 to 13 ± 4 mmHg, P = 0.002), cardiac output (from 5.4 ± 1.4 to 6.4 ± 2.1 l/minute, P = 0.001), and central venous oxygen saturation (from 81 ± 7 to 83 ± 7%, P = 0.001). There were significant increases in small perfused vessel density (from 10.96 ± 2.98 to 11.99 ± 2.55 vessels/mm(2), P = 0.009), proportion of small perfused vessels (from 85 ± 18 to 92 ± 14%, P = 0.002), and small microvascular flow index (from 2.45 ± 0.61 to 2.80 ± 0.68, P = 0.009) when compared with a mean arterial pressure of 65 mmHg.
  
  
  CONCLUSIONS
  Increasing mean arterial pressure from 65 mmHg to normal levels is associated with improved microcirculation in hypertensive septic shock patients.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT01443494; registered 28 September 2011.
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. xujingyuanmail@163.com.
authors.forename: Jing-Yuan
authors.initials: JY
authors.lastname: Xu
authors.affiliation: Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xining, 810000, P.R. China. siqing177@sina.com.
authors.forename: Si-Qing
authors.initials: SQ
authors.lastname: Ma
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. panchun1982@gmail.com.
authors.forename: Chun
authors.initials: C
authors.lastname: Pan
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. hhl0408@163.com.
authors.forename: Hong-Li
authors.initials: HL
authors.lastname: He
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. cccsssxxx1980@163.com.
authors.forename: Shi-Xia
authors.initials: SX
authors.lastname: Cai
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. shulinghu2013@163.com.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Hu
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. airanliu2013@gmail.com.
authors.forename: Ai-Ran
authors.initials: AR
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. liulingdoctor@gmail.com.
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. yz_huang@126.com.
authors.forename: Ying-Zi
authors.initials: YZ
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. fmguo2003@139.com.
authors.forename: Feng-Mei
authors.initials: FM
authors.lastname: Guo
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. yiyiyang2004@163.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, P.R. China. haiboq2000@163.com.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Qiu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure / Q000187:drug effects*; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007362:Intensive Care Units; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply; D009638:Norepinephrine / Q000008:administration & dosage / Q000494:pharmacology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine