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ABSTRACT: Background
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.Methods
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.Results
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.Conclusion
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.
SUBMITTER: Fage N
PROVIDER: S-EPMC9391564 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
Fage Nicolas N Demiselle Julien J Seegers Valérie V Merdji Hamid H Grelon Fabien F Mégarbane Bruno B Anguel Nadia N Mira Jean-Paul JP Dequin Pierre-François PF Gergaud Soizic S Weiss Nicolas N Legay François F Le Tulzo Yves Y Conrad Marie M Coudroy Remi R Gonzalez Frédéric F Guitton Christophe C Tamion Fabienne F Tonnelier Jean-Marie JM Bedos Jean Pierre JP Van Der Linden Thierry T Vieillard-Baron Antoine A Mariotte Eric E Pradel Gaël G Lesieur Olivier O Ricard Jean-Damien JD Hervé Fabien F Du Cheyron Damien D Guerin Claude C Mercat Alain A Teboul Jean-Louis JL Radermacher Peter P Asfar Pierre P
Annals of intensive care 20220819 1
<h4>Background</h4>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.<h4>Methods</h4>The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared ...[more]