High MAP in Septic Shock With Hypertension

Study Overview
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Brief Summary
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We hypothesized that the increase in MAP from 65 mmHg to patients' usual level improved sublingual microcirculation.

Detailed Description
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The effect of mean arterial pressure (MAP) titration to higher level on microcirculation in septic shock patients with previous hypertension remains unknown. Our goal was to assess the effect of MAP titration to patients' usual level on microcirculation in septic shock patients with previous hypertension. We hypothesized that the increase in MAP from 65 mmHg to patients' usual level improved sublingual microcirculation.

Official Title
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High Mean Arterial Pressure Target Improves Microcirculation in Septic Shock Patients With Previous Hypertension

Conditions
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Septic Shock

Intervention / Treatment
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* Other: NE


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with septic shock for less than 24 hours Fluid resuscitation was performed according to the guideline for treating septic shock to maintain the central venous pressure (CVP) for more than 8 mm Hg and central venous oxygen saturation for more than 70% Patients requiring norepinephrine (NE) to maintain a MAP of 65 mm Hg. Septic shock patients with fluid resuscitation after CVP > 8mmHg and mean blood pressure > 65 mmHg Exclusion Criteria: Pregnancy Age < 18 years Inability to acquire the usual level of MAP Refusal of consent by the patient or relative Participation in other trials during the last three months Hypertensive patients without hypertension treatment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: NE group<br>Adjust NE dose to titrate MAP to usual level regardless of fluid responsiveness when after EGDT. | Other: NE<br>* norepinephine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Arterial Pressure | As chronic hypertensive patients were supposed to have undergone more blood pressure measurements in daily life than non-hypertensive ones, the averaged MAP acquired from patients' physical examination records of the last two years was registered and assumed as patients' usual level of MAP and target MAP. If patients' medical records were incomplete, a detailed enquiry about the target MAP to their next kin was performed. After stabilization for 30 min, basal measurements including hemodynamic and microcirculatory measurements were taken, 20 min apart, the NE doses were increased to titrate MAP to the target level. Patients were allowed to stabilize for 30 min before taking new measurements. | Target MAP stabilization for 30 min | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perfused Vessel Density | Increasing MAP from 65 mm Hg to target level. The sublingual microcirculation was measured by sidestream dark field, including the parameters of perfused vessel density | Target MAP stabilization for 30 min | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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microcirculation, septic shock, norepinephrine, fluid