All authors: Anesthesiology, Pain and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil.
Crit Care Med. 2019 Aug;47(8):1033-1040. doi: 10.1097/CCM.0000000000003795.
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).
Prospective, nonblinded, interventional study.
Three ICUs in two teaching hospitals.
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.
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).
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 to 18.6 ± 4.5 mm/mm; arterial hypertension: 16.4 ± 3.5 mm/mm to 19.1 ± 3 mm/mm; 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.
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.
评估在合并先前全身性高血压的脓毒性休克患者中，与无高血压患者（对照组）相比，升高平均动脉压是否会改变微循环和全身血液动力学变量。
前瞻性、非盲、干预性研究。
两家教学医院的三个 ICU。
在获得知情同意后，我们纳入了至少 6 小时脓毒性休克、镇静和机械通气的年龄大于 18 岁的患者。我们通过年龄对有和无高血压的患者进行配对。
在获得系统性和微循环基础血液动力学变量（时间 0）后，我们增加去甲肾上腺素剂量以将平均动脉压升高至 85-90mmHg，然后再收集一组新的测量值（时间 1）。
我们共纳入了 40 名患者（每组 20 名）。两组之间的年龄无显著差异。在平均动脉压升高后，两组的心指数均显著增加，乳酸略有但显著降低。我们观察到灌注血管比例有显著改善（对照组：57.2±14%至 66±14.8%；高血压组：61.4±12.3%至 70.8±7.1%；组间：p=0.29；T0 和 T1：p<0.001；组间和时间交互作用：p=0.85）；灌注血管密度（对照组：15.6±4mm/mm 至 18.6±4.5mm/mm；高血压组：16.4±3.5mm/mm 至 19.1±3mm/mm；组间：p=0.51；T0 和 T1：p<0.001；组间和时间交互作用：p=0.70）和微循环血流指数（对照组：2.1±0.6 至 2.4±0.6；高血压组：2.1±0.5 至 2.6±0.2；组间：p=0.71；T0 和 T1：p=0.002；组间和时间交互作用：p=0.45）在两组中均有改善。
脓毒性休克患者用去甲肾上腺素升高平均动脉压可改善舌下微循环小血管的密度和血流。然而，这种改善既发生在合并先前高血压的患者中，也发生在无高血压的患者中。
