The Effect of Increasing the Mean Arterial Pressure on the Microcirculation and the Prognosis of Patients With Septic Shock

Background Whether or not norepinephrine infusions for support of hemodynamic status in patients with septic shock should be weight based is unknown. This situation is particularly pertinent in patients who are extremely overweight or obese. Objective To compare dosing requirements and effect of norepinephrine on blood pressure in obese and nonobese patients with septic shock. Methods In a retrospective cohort study, data on adult patients with septic shock who received norepinephrine infusion for support of hemodynamic status in a tertiary care, academic medical center were analyzed. Patients were categorized as obese (body mass index ≥ 30) or nonobese (body mass index < 30). The primary outcome was dosing requirements of norepinephrine at 60 minutes after the start of the infusion. The secondary outcome was the log-transformed ratio of mean arterial pressure to norepinephrine. Results The final cohort consisted of 100 obese and 100 nonobese patients. Mean norepinephrine infusion rate at 60 minutes was 0.09 (SD, 0.08) μg/kg per minute in the obese group and 0.13 (SD, 0.14) μg/kg per minute in the nonobese group (P = .006). The non–weight-based dose at 60 minutes was 9 μg/min in obese patients and 8 μg/min in nonobese patients (P = .72). The log transformed mean arterial pressure to norepinephrine ratio at 60 minutes was 2.5 (SD, 0.9) in obese patients and 2.5 (SD, 0.8) in nonobese patients (P = .54) Conclusions Compared with nonobese patients, obese patients with septic shock require lower weight-based doses of norepinephrine and similar total norepinephrine doses.

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Impact of individualized target mean arterial pressure for septic shock resuscitation on the incidence of acute kidney injury: a retrospective cohort study

Annals of Intensive Care ◽

10.1186/s13613-018-0468-5 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 7

Author(s):

Rajat N. Moman ◽

Stuart A. Ostby ◽

Abbasali Akhoundi ◽

Rahul Kashyap ◽

Kianoush Kashani

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Cohort Study ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Kidney Injury

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Pharmacological modulation of procoagulant microparticles improves haemodynamic dysfunction during septic shock in rats

Thrombosis and Haemostasis ◽

10.1160/th13-04-0313 ◽

2014 ◽

Vol 111 (01) ◽

pp. 154-164 ◽

Cited By ~ 18

Author(s):

Su-Emmanuelle Degirmenci ◽

Fatiha Zobairi ◽

Asael Berger ◽

Grégory Meyer ◽

Mélanie Burban ◽

...

Keyword(s):

Septic Shock ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Vascular Dysfunction ◽

Vascular Inflammation ◽

Activated Protein C ◽

Resistance Arteries ◽

Pharmacological Modulation ◽

Circulating Microparticles ◽

Haemodynamic Improvement

SummaryCirculating microparticles play a pro-inflammatory and procoagulant detrimental role in the vascular dysfunction of septic shock. It was the objective of this study to investigate mechanisms by which a pharmacological modulation of microparticles could affect vascular dysfunction in a rat model of septic shock. Septic or sham rats were treated by activated protein C (aPC) and resuscitated during 4 hours. Their microparticles were harvested and inoculated to another set of healthy recipient rats. Haemodynamic parameters were monitored, circulating total procoagulant microparticles assessed by prothrombinase assay, and their cell origin characterised. Mesenteric resistance arteries, aorta and heart were harvested for western blotting analysis. We found that a) the amount and phenotype of circulating microparticles were altered in septic rats with an enhanced endothelial, leucocyte and platelet contribution; b) aPC treatment significantly reduced the generation of leucocyte microparticles and norepinephrine requirements to reach the mean arterial pressure target in septic rats; c) Microparticles from untreated septic rats, but not from aPC-treated ones, significantly reduced the healthy recipients’ mean arterial pressure; d) Microparticle thromboxane content and aPC activity were significantly increased in aPC-treated septic rats. In inoculated naïve recipients, microparticles from aPC-treated septic rats prompted reduced NF-κB and cyclooxygenase-2 arterial activation, blunted the generation of pro-inflammatory iNOS and secondarily increased platelet and endothelial microparticles. In conclusion, in this septic shock model, increased circulating levels of procoagulant microparticles led to negative haemodynamic outcomes. Pharmacological treatment by aPC modified the cell origin and levels of circulating microparticles, thereby limiting vascular inflammation and favouring haemodynamic improvement.

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Correlation between Calcium Phosphorus Product and Mean Arterial Pressure among Hemodialysis Patients with End Stage Renal Disease

The International Journal of Frontier Sciences ◽

10.37978/tijfs.v5i1.324 ◽

2020 ◽

Vol 5 (1) ◽

Author(s):

Muhammad Nadeem ◽

Mansoor Abbas Qaisar ◽

Ali Hassan Al Hakami ◽

Fateh Sher Chattah ◽

Muhammad Muzammil ◽

...

Keyword(s):

Mean Arterial Pressure ◽

Arterial Pressure ◽

Renal Disease ◽

End Stage Renal Disease ◽

Hemodialysis Patients ◽

Age Group ◽

Calcium Phosphorus ◽

The Mean ◽

Stage Renal Disease ◽

End Stage

Background: The mean arterial pressure serves as an expression of blood pressure in patients on chronic hemodialysis. Serum calcium phosphorus product is considered as a risk factor of vascular calcification that is associated with hypertension in the patients of end stage renal disease. The literature regarding this relationship is inconsistent therefore this study is designed to determine the correlation between calcium phosphorus product and mean arterial pressure among hemodialysis patients with end stage renal disease. Methods: A total of 110 patients of end stage renal disease on hemodialysis for at least one year, 20 to 60 years of age were included. Patients with primary or tertiary hyperparathyroidism, peripheral vascular disease, malignancy, hypertension secondary to any cause other than kidney disease were excluded. Mean arterial pressure was calculated according to the standard protocol in lying position. Blood samples for estimation of serum calcium and phosphorous were taken and was sent immediately to the laboratory for serum analysis. Results: Mean age was 44.17 ± 10.94 years. Mean calcium phosphorous product was 46.71 ± 7.36 mg/dl and mean arterial pressure was 103.61 ± 12.77 mmHg. The values of Pearson correlation co-efficient (r) were 0.863 for age group 20 to 40 years and 0.589 for age group 41 to 60 years. This strong positive correlation means that high calcium phosphorous product goes with high mean arterial pressure (and vice versa) for both the age groups. Conclusion: A strong positive relationship exists between the mean arterial pressure and calcium phosphorous product and is independent of patients’ age.

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Hubungan Mean Arterial Pressure (MAP) Dengan Preeklamsia Pada Ibu Hamil Di Puskesmas Bontobangun Kabupaten Bulukumba

Jurnal Kesehatan Panrita Husada ◽

10.37362/jkph.v5i2.376 ◽

2020 ◽

Vol 5 (2) ◽

pp. 138-145

Author(s):

Ely Kurniati ◽

Rusnawati

Keyword(s):

Mean Arterial Pressure ◽

Arterial Pressure ◽

Pregnant Women ◽

Sampling Method ◽

Blood Pressure Measurement ◽

Test Results ◽

Historical Cohort ◽

Measurement Results ◽

History Of ◽

The Mean

Preeclampsia complicates 4-7% of pregnancies and remains the leading cause of maternal and fetal morbidity and mortality worldwide. Despite improvements in health care over the last decade, preeclampsia remains the second most common cause of maternal mortality in Indonesia. This study aims to determine whether the mean arterial pressure (MAP) is related to the incidence of preeclampsia in pregnant women at the Bontobangun Puskesmas, Bulukumba district for the period 2018 to 2019. This research uses a descriptive-analytic approach with Historical Cohort Studies, namely by looking at the cohort book of the history of blood pressure measurement results for pregnant women at the Bontobangun Public Health Center, Bulukumba Regency for the period 2018 to 2019. Determining the sample using the sampling method taken by purposive sampling. 31 samples of pregnant women who experienced preeclampsia and 31 controls were pregnant women with normal conditions who had certain criteria (matching) with the sample. The results explained that from the paired T-test results, the value of α> 0.037 so that it is said that there is a relationship between mean artery pressure (MAP) and the incidence of preeclampsia in pregnant women at Bontobangun puskesmas for the period 2018-2019.

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The Use of Biochemical and Biophysical Markers in Early Screening for Preeclampsia in Mongolia

Medical Sciences ◽

10.3390/medsci6030057 ◽

2018 ◽

Vol 6 (3) ◽

pp. 57

Author(s):

Urjindelger Tserensambuu ◽

Ariunbold Chuluun-Erdene ◽

Munkhtsetseg Janlav ◽

Erkhembaatar Tudevdorj

Keyword(s):

Mean Arterial Pressure ◽

Arterial Pressure ◽

Pulsatility Index ◽

Uterine Artery ◽

Maternal Serum ◽

Operating Characteristics ◽

Early Screening ◽

Roc Curve Analysis ◽

Detection Rates ◽

The Mean

Preeclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality, particularly in developing countries. In Mongolia, preeclampsia and eclampsia have occurred among pregnancy complications at a rate of 25% in recent years. Recent studies in the literature have screened for preeclampsia by combining maternal factors with biomarkers. This study was conducted using prospective cohort research including 393 singleton pregnancies at 11–13+6 weeks. Maternal plasmas pregnancy-associated plasma protein-A (PAPP-A) and maternal serum placental growth factor (PlGF) were measured using Perkin Elmer time-resolved fluoroimmunoassay (DELFIA) kits, and the measurement of mean arterial pressure (MAP) was performed by automated devices and the uterine artery pulsatility index was measured by Doppler ultrasound. In the study population, there were 16.7% showing complicated preeclampsia. The receiver-operating characteristics (ROC) curve analysis showed a sensitivity of 71.21%, and a specificity of 75.54% when the mean arterial pressure cut-off was 89.5 mm; while a sensitivity of 33.36% and specificity of 77.68% were observed when the uterine artery mean pulsatility index (mPI) cut-off was 2.34; a sensitivity of 79.66% and specificity of 44.04% were observed when the PAPP-A cut-off was 529.1 mU/L; and a sensitivity of 74.58% and specificity of 46.6% were observed when the PlGF cut-off was 39.87 pg/mL. The detection rates following the combination of markers with the maternal history were as follows: 62.7% with mean arterial pressure, 69.5–82.9% with two markers 86.5% with three markers and 91.4% with four markers. In conclusion, the mean arterial pressure was highly sensitive and demonstrated its easy usage and cost-effectiveness as a predictive marker for the early screening of preeclampsia from other biomarkers.

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