Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial - Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 Access content directly
Journal Articles (Review Article) Annals of Intensive Care Year : 2022

Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial

Bruno Mégarbane
Jean-Paul Mira
  • Function : Author
  • PersonId : 928244
Remi Coudroy
  • Function : Author
Jean Pierre Bedos
  • Function : Author
Antoine Vieillard-Baron
Eric Mariotte
  • Function : Author
Gaël Pradel
  • Function : Author
Olivier Lesieur
  • Function : Author
Jean-Damien Ricard
  • Function : Author
Fabien Hervé
  • Function : Author
Damien Du Cheyron
  • Function : Author
Claude Guerin
  • Function : Author
Alain Mercat
  • Function : Author
Jean-Louis Teboul
  • Function : Author
Peter Radermacher
  • Function : Author
Pierre Asfar

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.
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Dates and versions

hal-03980601 , version 1 (02-03-2023)

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Nicolas Fage, Julien Demiselle, Valérie Seegers, Hamid Merdji, Fabien Grelon, et al.. Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial. Annals of Intensive Care, 2022, 12 (1), pp.78. ⟨10.1186/s13613-022-01053-1⟩. ⟨hal-03980601⟩
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