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Critical Care  2013 

Increasing mean arterial blood pressure in sepsis: effects on fluid balance, vasopressor load and renal function

DOI: 10.1186/cc12495

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Twenty-four anesthetized and mechanically ventilated pigs were randomly assigned (n = 8 per group) to a septic control group (Septic-CG) without resuscitation until death or one of two groups in which resuscitation was performed after 12 hours of untreated sepsis for 48 hours, targeting MAP between 50 and 60 mmHg (Low-MAP) or between 75 and 85 mmHg (High-MAP).MAP at the end of resuscitation was 56+/-13 mmHg (mean+/-SD) and 76+/-17 mmHg respectively, for Low-MAP and High-MAP groups. One animal each in High- and Low-MAP groups, and all animals in the septic control group died [median survival time: 21.8 hours (inter-quartile range: 16.3-27.5 hours). Norepinephrine was administered to all animals of the High-MAP group [0.38 (0.21-0.56) mcg/kg/min], and to three animals of the Low-MAP group [0.00 (0.00-0.25) mcg/kg/min; p=0.009]. The High-MAP group had a more positive fluid balance (3.3+/-1.0 ml/kg/h vs. 2.3+/-0.7 ml/kg/h; p=0.001). Inflammatory markers, skeletal muscle ATP content and hemodynamics other than MAP did not differ between Low- and High-MAP groups. The incidence of acute kidney injury (AKI) after 12 hours of untreated sepsis was, respectively for Low- and High-MAP groups, 50% (4/8) and 38% (3/8), and in the end of the study 57% (4/7) and 0% (p=0.026). In Septic-CG, maximal isolated skeletal muscle mitochondrial Complex I, State 3 respiration increased from 1357+/-149 pmol/s/mg to 1822+/-385 pmol/s/mg, (p=0.020). In High- and Low-MAP groups, permeabilized skeletal muscle fibers Complex IV-state 3 respiration increased during resuscitation (p=0.003).The MAP targets during resuscitation did not alter the inflammatory response, nor affected skeletal muscle ATP content and mitochondrial respiration. While targeting a lower MAP was associated with increased incidence of AKI, targeting a higher MAP resulted in increased net positive fluid balance and vasopressor load during resuscitation. The long-term effects of using lower MAP targets on kidney function and whet


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