Effect of Increasing Blood Pressure With Noradrenaline on the Microcirculation of Patients With Septic Shock and Previous Arterial Hypertension

Author(s)

Fiorese Coimbra, Karla Tuanny ^[1] ; Rezende de Freitas, Flavio Geraldo ^[1] ; Bafi, Antonio Tonete ^[1] ; Pinheiro, Tuanny Teixeira ^[1] ; Nunes, Nathaly Fonseca ^[1] ; Pontes de Azevedo, Luciano Cesar ^[1] ; Machado, Flavia Ribeiro ^[1]

Affiliation

^[1] Univ Fed Sao Paulo, Anesthesiol Pain & Intens Care Dept, Sao Paulo - Brazil

• Document type: Journal article
• Source: Critical Care Medicine; v. 47, n. 8, p. 1033-1040, AUG 2019.
• Web of Science Citations: 2

Abstract

Objectives: To assess whether an increase in mean arterial pressure in patients with septic shock and previous systemic arterial hypertension changes microcirculatory and systemic hemodynamic variables compared with patients without arterial hypertension (control). Design: Prospective, nonblinded, interventional study. Setting: Three ICUs in two teaching hospitals. Patients: After informed consent, we included patients older than 18 years with septic shock for at least 6 hours, sedated, and under mechanical ventilation. We paired patients with and without arterial hypertension by age. Interventions: After obtaining systemic and microcirculation baseline hemodynamic variables (time 0), we increased noradrenaline dose to elevate mean arterial pressure up to 85-90 mm Hg before collecting a new set of measurements (time 1). Measurements and Main Results: We included 40 patients (20 in each group). There was no significant difference in age between the groups. After the rise in mean arterial pressure, there was a significant increase in cardiac index and a slight but significant reduction in lactate in both groups. We observed a significant improvement in the proportion of perfused vessels (control: 57.2 +/- 14% to 66 +/- 14.8%; arterial hypertension: 61.4 +/- 12.3% to 70.8 +/- 7.1%; groups: p = 0.29; T0 and T1: p < 0.001; group and time interaction: p = 0.85); perfused vessels density (control: 15.6 +/- 4 mm/mm(2) to 18.6 +/- 4.5 mm/mm(2); arterial hypertension: 16.4 +/- 3.5 mm/mm(2) to 19.1 +/- 3 mm/mm(2); groups: p = 0.51; T0 and T1: p < 0.001; group and time interaction: p = 0.70), and microcirculatory flow index (control: 2.1 +/- 0.6 to 2.4 +/- 0.6; arterial hypertension: 2.1 +/- 0.5 to 2.6 +/- 0.2; groups: p = 0.71; T0 and T1: p = 0.002; group and time interaction: p = 0.45) in both groups. Conclusions: Increasing mean arterial pressure with noradrenaline in septic shock patients improves density and flow in small vessels of sublingual microcirculation. However, this improvement occurs both in patients with previous arterial hypertension and in those without arterial hypertension. (AU)

• FAPESP's process: 12/19051-1 - Effects of rising arterial blood pressure with noradrenaline in the microcirculation of septic shock patients and previous arterial hypertension
• Grantee: Flavia Ribeiro Machado
• Support Opportunities: Regular Research Grants