NDLI: Diastolic arterial blood pressure: a reliable early predictor of survival in human septic shock.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Benchekroune, Samir Karpati, Peter C. J. Berton, Christine Nathan, Cédric Mateo, Joaquim Chaara, Mansour Riché, Florence Laisné, Marie-Josèphe Payen, Didier Mebazaa, Alexandre
Description	Country affiliation: France Author Affiliation: Benchekroune S ( Department of Anesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.)
Abstract	BACKGROUND: Emphasis in therapy of human septic shock is shifting towards reliable end points and predictors of survival. Rationale is to study whether the evolution of cardiovascular reactivity in view of the administered doses of norepinephrine is an early predictor of in-hospital survival and to determine the optimal threshold of norepinephrine therapy and its consequences on renal function. METHODS: Observational study of a prospective cohort of patients in septic shock, hospitalized in intensive care unit at least 24 hours before requiring norepinephrine. Excluded were patients requiring <72 hours of continuous norepinephrine (16 patients) or who received corticosteroids. Hemodynamic parameters (heart rate, blood pressure, urinary output, and temperature) were continuously monitored. RESULTS: Of 68 patients, 45 survived [intensive care unit stay of 24 (12-36) days, hospital stay of 36 (27-66) days], and 23 died 5 (3-10) days after septic shock onset and norepinephrine treatment. Multivariate analysis revealed four independent positive predictive factors of short-term (10 days) outcome: Simplified Acute Physiology Score (SAPS) II <50 [odds ratio (OR) 6.4, 95% confidence interval (95% CI) 1.3-30.7, p < 0.011], and on day 3 Logistic Organ Dysfunction System (LODS) score <6 (OR 29.1, 95% CI 2.7-314.3, p = 0.0056), norepinephrine concentration <0.5 mug/kg/min (OR 17.6, 95% CI 2.2-142.0, p < 0.0007), diastolic arterial pressure >50 mm Hg (OR 24.8, 95% CI 2.9-215.9, p < 0.004), but not systolic arterial pressure. CONCLUSIONS: Septic shock survival increases when dose of 0.5 mug/kg/min of norepinephrine continuously improves vascular tone within the first 48 hours, or when diastolic arterial pressure (>50 mm Hg) is restored. Norepinephrine has beneficial effects on renal function. Predictive value of LODS score on day 3 is demonstrated, while SAPS II is confirmed as the only reliable predictive factor in first 24 hours.
File Format	HTM / HTML
ISSN	00225282
Issue Number	5
Volume Number	64
e-ISSN	15298809
Journal	The Journal of Trauma: Injury, Infection, and Critical Care
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-05-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Blood Pressure Prognosis Microbiology Humans Middle Aged Male Roc Curve Journal Article Kidney Function Tests Female Intensive Care Units Clinical Trial Mortality Drug Therapy Dobutamine Pharmacology Apache Drug Effects Discipline Traumatology Therapeutic Use Cardiotonic Agents Shock, Septic Vasoconstrictor Agents Survival Analysis Norepinephrine Aged Hemodynamics
Content Type	Text
Resource Type	Article
Subject	Surgery Critical Care and Intensive Care Medicine

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