Effects of rising arterial blood pressure with noradrenaline in the microcirculation of septic shock patients and previous arterial hypertension

• Grant number: 12/19051-1
• Support Opportunities: Regular Research Grants
• Start date: March 01, 2013
• End date: August 31, 2016
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Flavia Ribeiro Machado
• Grantee: Flavia Ribeiro Machado
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil
• Associated researchers: Antonio Tonete Bafi ; Flávio Geraldo Rezende de Freitas ; Karla Tuanny Fiorese Coimbra ; Luciano Cesar Pontes de Azevedo ; Nathaly Fonseca Nunes

Abstract

The optimal levels of mean arterial pressure that must be achieved in septic shock are subject of debate. Studies tried to correlate blood pressure increase in patients with septic shock with microcirculation. However, there are few studies that specifically assessed septic shock patients with previous arterial hypertension. The main objective of this study is to evaluate the effect of increased blood pressure level in the microcirculation of these patients. This is a prospective clinical trial to be conduct in the intensive care units of the Departamento de Anestesiologia, Dor e Terapia Intensiva from the Universidade Federal de São Paulo and the intensive care unit of Hospital do Rim e Hipertensão. Forty patients will be included, being 20 without known history of systemic arterial hypertension and 20 with this diagnosis for at least 2 years and already with clinical or subclinical organ damage. Inclusion criteria are as follows: age over than 18 years old, norepinephrine drug use for at least 12 hours and for less than 48 hours, sedation level equal or deeper than Ramsay 4, blood pressure stable for the last 30 minutes prior to inclusion, central venous catheter in place and signed informed consent. Exclusion criteria will be pregnancy, cirrhosis, systemic sclerosis, and need to maintain mean arterial pressure above 65mmHg for others conditions and norephinephrine doses < 0,1 µg/Kg/min or e 1,0 µg/Kg/min. We will assess hemodynamic and sublingual microcirculation variables using sidestream darkfield which will be analyzed through a specific software. The changes in hemodynamic variables and in microcirculation will be compared in both groups before and after the blood pressure rise. We expect a microcirculation improvement only in the previously hypertensive patients. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

FIORESE COIMBRA, KARLA TUANNY; REZENDE DE FREITAS, FLAVIO GERALDO; BAFI, ANTONIO TONETE; PINHEIRO, TUANNY TEIXEIRA; NUNES, NATHALY FONSECA; PONTES DE AZEVEDO, LUCIANO CESAR; MACHADO, FLAVIA RIBEIRO. Effect of Increasing Blood Pressure With Noradrenaline on the Microcirculation of Patients With Septic Shock and Previous Arterial Hypertension. Critical Care Medicine, v. 47, n. 8, p. 1033-1040, AUG 2019. (12/19051-1)