Annals of Intensive Care (Aug 2022)
Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial
- Nicolas Fage,
- Julien Demiselle,
- Valérie Seegers,
- Hamid Merdji,
- Fabien Grelon,
- Bruno Mégarbane,
- Nadia Anguel,
- Jean-Paul Mira,
- Pierre-François Dequin,
- Soizic Gergaud,
- Nicolas Weiss,
- François Legay,
- Yves Le Tulzo,
- Marie Conrad,
- Remi Coudroy,
- Frédéric Gonzalez,
- Christophe Guitton,
- Fabienne Tamion,
- Jean-Marie Tonnelier,
- Jean Pierre Bedos,
- Thierry Van Der Linden,
- Antoine Vieillard-Baron,
- Eric Mariotte,
- Gaël Pradel,
- Olivier Lesieur,
- Jean-Damien Ricard,
- Fabien Hervé,
- Damien Du Cheyron,
- Claude Guerin,
- Alain Mercat,
- Jean-Louis Teboul,
- Peter Radermacher,
- Pierre Asfar
Affiliations
- Nicolas Fage
- Department of Medical Intensive Care, University Hospital of Angers
- Julien Demiselle
- Department of Intensive Care (Service de Médecine Intensive – Réanimation), Nouvel Hôpital Civil, University Hospital of Strasbourg
- Valérie Seegers
- Service de Biométrie, Institut de Cancérologie de L’Ouest, Centre Paul Papin
- Hamid Merdji
- Department of Intensive Care (Service de Médecine Intensive – Réanimation), Nouvel Hôpital Civil, University Hospital of Strasbourg
- Fabien Grelon
- Medical and Surgical Intensive Care Unit, Le Mans Hospital
- Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, INSERM UMRS-1144
- Nadia Anguel
- Department of Medical Intensive Care, Bicêtre University Hospital, AP-HP, Paris-Saclay University
- Jean-Paul Mira
- Department of Medical Intensive Care, Cochin University Hospital
- Pierre-François Dequin
- Department of Medical Intensive Care, Tours University Hospital
- Soizic Gergaud
- Department of Surgical Intensive Care, University Hospital of Angers
- Nicolas Weiss
- Department of Medical Intensive Care, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris
- François Legay
- Medical and Surgical Intensive Care Unit, Saint Brieuc Hospital
- Yves Le Tulzo
- Department of Infectious Diseases and Medical Intensive Care, Rennes University Hospital
- Marie Conrad
- Department of Medical Intensive Care, Nancy University Hospital
- Remi Coudroy
- Department of Medical Intensive Care, Université de Poitiers, CHU Poitiers
- Frédéric Gonzalez
- Department of Medical and Surgical Intensive Care, Avicenne Teaching Hospital
- Christophe Guitton
- Department of Medical Intensive Care, Nantes University Hospital
- Fabienne Tamion
- Department of Medical Intensive Care, Rouen University Hospital
- Jean-Marie Tonnelier
- Department of Medical Intensive Care, Brest University Hospital
- Jean Pierre Bedos
- Intensive Care Unit, Versailles Hospital
- Thierry Van Der Linden
- Department of Intensive Care, Saint Philibert Hospital, Catholic University of Lille
- Antoine Vieillard-Baron
- Department of Medical Intensive Care, University Hospital of Ambroise Paré
- Eric Mariotte
- Department of Intensive Care, Saint Louis Hospital
- Gaël Pradel
- Department of Intensive Care, Avignon Hospital
- Olivier Lesieur
- Department of Medical and Surgical Intensive Care, La Rochelle Saint Louis Hospital
- Jean-Damien Ricard
- Université de Paris, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive Réanimation
- Fabien Hervé
- Department of Medical and Surgical Intensive Care, Quimper Hospital
- Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital
- Claude Guerin
- Department of Medical Intensive Care, Edouard Herriot Hospital
- Alain Mercat
- Department of Medical Intensive Care, University Hospital of Angers
- Jean-Louis Teboul
- Department of Medical Intensive Care, Bicêtre University Hospital, AP-HP, Paris-Saclay University
- Peter Radermacher
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum
- Pierre Asfar
- Department of Medical Intensive Care, University Hospital of Angers
- DOI
- https://doi.org/10.1186/s13613-022-01053-1
- Journal volume & issue
-
Vol. 12,
no. 1
pp. 1 – 10
Abstract
Abstract Background In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock. Methods The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared mottling and lactate time course between the two MAP target groups. We evaluated the patient’s outcome according to the presence or absence of mottling. Results We included 747 patients, 374 were assigned to the low-MAP group and 373 to the high-MAP group. There was no difference in mottling and lactate evolution during the first 24 h between the two MAP groups. After adjustment for MAP and confounding factors, the presence of mottling ≥ 6 h during the first 24 h was associated with a significantly higher risk of death at day 28 and 90. Patients without mottling or with mottling < 6 h and lactate ≥ 2 mmol/L have a higher probability of survival than those with mottling ≥ 6 h and lactate < 2 mmol/L. Conclusion Compared with low MAP target, higher MAP target did not alter mottling and lactate course. Mottling lasting for more than 6 h was associated with higher mortality. Compared to arterial lactate, mottling duration appears to be a better marker of mortality.
Keywords
