Fage Nicolas, Demiselle Julien, Seegers Valérie, Merdji Hamid, Grelon Fabien, Mégarbane Bruno, Anguel Nadia, Mira Jean-Paul, Dequin Pierre-François, Gergaud Soizic, Weiss Nicolas, Legay François, Le Tulzo Yves, Conrad Marie, Coudroy Remi, Gonzalez Frédéric, Guitton Christophe, Tamion Fabienne, Tonnelier Jean-Marie, Bedos Jean Pierre, Van Der Linden Thierry, Vieillard-Baron Antoine, Mariotte Eric, Pradel Gaël, Lesieur Olivier, Ricard Jean-Damien, Hervé Fabien, Du Cheyron Damien, Guerin Claude, Mercat Alain, Teboul Jean-Louis, Radermacher Peter, Asfar Pierre
Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
MITOVASC Laboratory UMR INSERM (French National Institute of Health and Medical Research), 1083 - CNRS 6015, University of Angers, Angers, France.
Ann Intensive Care. 2022 Aug 19;12(1):78. doi: 10.1186/s13613-022-01053-1.
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.
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.
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.
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.
在感染性休克患者中，平均动脉压（MAP）目标对皮肤花斑病程的影响仍不确定。在这项对SEPSISPAM试验的事后分析中，我们研究了低MAP（65至70 mmHg）或高MAP目标（80至85 mmHg）是否会影响感染性休克患者的皮肤花斑病程和动脉血乳酸水平。
从纳入研究后2小时至停用儿茶酚胺期间，每2小时评估一次皮肤花斑情况。我们比较了两个MAP目标组之间皮肤花斑和乳酸水平的时间进程。我们根据有无皮肤花斑评估患者的预后。
我们纳入了747例患者，374例被分配到低MAP组，373例被分配到高MAP组。两个MAP组在最初24小时内皮肤花斑和乳酸水平的变化没有差异。在调整MAP和混杂因素后，最初24小时内皮肤花斑持续≥6小时与第28天和第90天死亡风险显著升高相关。无皮肤花斑或皮肤花斑<6小时且乳酸水平≥2 mmol/L的患者比皮肤花斑≥6小时且乳酸水平<2 mmol/L的患者生存概率更高。
与低MAP目标相比，较高的MAP目标并未改变皮肤花斑和乳酸水平的病程。皮肤花斑持续超过6小时与较高的死亡率相关。与动脉血乳酸相比，皮肤花斑持续时间似乎是更好的死亡标志物。
