Effects of mean arterial pressure on arousal in sedated ventilated patients with septic shock: a SEPSISPAM post hoc exploratory study

Youenn Jouan; Valerie Seegers; Ferhat Meziani; Fabien Grelon; Bruno Mégarbane; Nadia Anguel; Jean-Paul Mira; Pierre-François Dequin; Soizic Gergaud; Nicolas Weiss; François Legay; Yves Le Tulzo; Marie Conrad; Rene Robert; Frédéric Gonzalez; Christophe Guitton; Fabienne Tamion; Jean-Marie Tonnelier; Pierre Guezennec; Thierry van der Linden; Antoine Vieillard-Baron; Peter Radermacher; Pierre Asfar

doi:10.1186/s13613-019-0528-5

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Effects of mean arterial pressure on arousal in sedated ventilated patients with septic shock: a SEPSISPAM post hoc exploratory study

Youenn Jouan ¹ Valerie Seegers ² Ferhat Meziani ³ Fabien Grelon ⁴ Bruno Mégarbane ⁵ Nadia Anguel ⁶ Jean-Paul Mira ^{7, 8} Pierre-François Dequin ⁹ Soizic Gergaud ¹⁰ Nicolas Weiss ¹¹ François Legay ^{12, 13} Yves Le Tulzo ¹⁴ Marie Conrad ¹⁵ Rene Robert ¹⁶ Frédéric Gonzalez ¹⁷ Christophe Guitton ¹⁸ Fabienne Tamion ¹⁹ Jean-Marie Tonnelier ²⁰ Pierre Guezennec ²¹ Thierry van der Linden ²² Antoine Vieillard-Baron ^{23, 24} Peter Radermacher ²⁵ Pierre Asfar ^{26, 27}

1 Service de Médecine Intensive Réanimation [Tours]

2 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]

3 Service de Réanimation Médicale [Strasbourg]

4 UM - Le Mans Université

5 Hôpital Lariboisière-Fernand-Widal [APHP]

6 AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)

7 Hôpital Cochin [AP-HP]

8 Hôpital Saint-Vincent de Paul

9 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours

10 Service d'anesthésie et réanimation chirurgicale

11 Service de Neurologie [CHU Pitié-Salpêtrière]

12 Centre hospitalier Saint-Brieuc

13 Hôpital Yves LE FOLL [Saint-Brieuc]

14 CHU Pontchaillou [Rennes]

15 Service de Réanimation Médicale [CHRU Nancy]

16 CHU Poitiers - Centre hospitalier universitaire de Poitiers

17 Département d'anesthésiologie et de soins intensifs [Institut Paoli-Calmettes, Marseille]

18 Centre Hospitalier Le Mans (CH Le Mans)

19 Service de réanimation médicale [CHU Rouen]

20 CHU - BREST - Réa Med - CHRU Brest - Service de Réanimation Médicale

21 Service de réanimation [CH Versailles]

22 Hôpital Saint Philibert [Lomme]

23 Medical Intensive Care Unit [Boulogne-Billancourt]

24 Hôpital Ambroise Paré [AP-HP]

25 Universitätsklinikum Ulm - University Hospital of Ulm

26 MITOVASC - Physiopathologie Cardiovasculaire et Mitochondriale

27 Département de Médecine Intensive et Réanimation [Angers]

Abstract : Background: It is unknown whether the recommended mean arterial pressure (MAP) target of 65 mmHg during initial resuscitation of septic shock is sufficient to maintain cerebral perfusion. Thus, we tested the hypothesis that a higher MAP target in patients with septic shock may improve level of arousal. Methods: We performed a post hoc exploratory analysis of the SEPSISPAM trial, which assessed the effect of a "high-target" level of MAP (80-85 mmHg) versus the recommended "low-target" MAP (65-70 mm Hg) on mortality in patients with septic shock. Among the 776 patients originally recruited in SEPSISPAM trial, we selected those who were mechanically ventilated and sedated and with available evaluation of arousal level assessed by the Richmond Agitation and Sedation Scale (RASS). Results: We restricted our analysis to the period in which patients were treated with vasoactive drugs. Cumulative sedative drugs were assessed daily. A total of 532 patients were included in this study: 253 (47.6%) in the low-target group and 279 (52.4%) in the high-target group. Daily cumulative sedative drugs were similar in both groups. Compared to the low-target group, minimal and maximal RASS were significantly higher in the high-target group at day 2, 4 and 5. Furthermore, in order to consider the fact that multiple measures were done for each patient and to consider the global effect of time on these measures, we used a mixed linear regression and multivariate models: we confirmed that maximal RASS values were significantly higher in the high-target group. Conclusion: In patients with septic shock who were mechanically ventilated and sedated, resuscitation with MAP target between 80 and 85 mmHg was associated with higher arousal level as compared to a MAP target between 65 and 70 mmHg.

Keywords : Vasopressors Cerebral perfusion Arousal Mean arterial pressure Sedation Septic shock

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https://hal.univ-angers.fr/hal-02616947
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Soumis le : mercredi 15 juillet 2020 - 13:44:18
Dernière modification le : vendredi 20 mai 2022 - 11:06:08
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