Associations between peripheral perfusion disorders, mean arterial pressure and dose of norepinephrine administrated in the early phase of septic shock

Abstract

The aim of the study was to explore the correlations between peripheral perfusion, mean arterial pressure and the dose‐rate of norepinephrine (NE) infused for the treatment of septic shock. The study is retrospective analysis of data acquired prospectively on 57 patients during the first 24 hours after the occurrence of the shock. Clinical and haemodynamic characteristics, skin perfusion parameters (capillary refill time [CRT], mottling score and temperature gradients) and the dose rate of NE infusion were collected. Negative correlations between mean arterial pressure (MAP) and temperature gradients (core‐to‐toe: P = .03, core‐to‐index: P = .04) were found and abnormal CRT was associated with lower MAP (P = .02). The dose rate of NE was negatively correlated with temperature gradients (core‐to‐toe: P = .02, core‐to‐index: P = .01, forearm‐to‐index: P = .008) in the overall population. In patients receiving NE for at least 12 hours, the NE dose rate positively was correlated with the mottling score (P = .006), temperature gradients (core‐to‐toe: P = .04, forearm‐to‐index: P = .02, core‐to‐index: P = .005) and CRT (P = .001). The dose of NE administrated was associated with 14‐days mortality (odds ration [OR] = 1.21 [1.06‐1.38], P = .006) and with 28‐days mortality (OR = 1.17 [1.01‐1.36], P = 0.04). In conclusion, the study described the presence of correlations between peripheral perfusion and MAP and between peripheral perfusion and the dose rate of NE infusion.

Modifications of peripheral perfusion in patients with vasopressor-dependent septic shock treated with polymyxin B-direct hemoperfusion

“…In this study, the dose of vasopressors in the abnormal PP group was significantly reduced 24 and 48 h after the initiation of PMX-DHP, while the PP improved. A negative correlation has been reported between vasopressor dose and PP 41 , and our results showed a similar correlation, albeit feeble. Therefore, we assume that the reduction in vasopressor dose may have been a factor that effectively improved abnormal PP, and PMX-DHP may be a useful intervention for patients with cold shock requiring vasopressors.…”

Correlation Between Mean Arterial Pressure and Capillary Refill Time in Patients with Septic Shock: A Systematic Review and Meta-analysis

“…7,12-20 A complete selection process is depicted in Figure 1. There were 917 patients coming from 8 observational studies 7,12-15,17,18,20 and 2 randomized controlled trials. 16,19 By using an original, adjusted quality tool, we identified 5 studies (542 patients) that scored 4/4 points and were considered “good” in regards to the review's aim (Table 1).…”

“…Additionally, studies with higher norepinephrine doses 16,18‐20 (“higher” doses are defined as those that are above the median of all doses of included studies) and with lower norepinephrine doses were assessed. 7,12,13,16,18 Both subgroup analyses failed to show a statistically significant correlation between CRT and MAP—higher versus lower dose: −0.126 (−0.253 to 0.00430) versus −0.138 (−0.272 to 0.0629) (Supplementary Figure 3).…”

“…There were 10 studies able to be included in the meta-analysis. 7,[12][13][14][15][16][17][18][19][20] A complete selection process is depicted in Figure 1. There were 917 patients coming from 8 observational studies 7,12-15,17,18,20 and 2 randomized controlled trials.…”

Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study

“…Установленное ПЗ оказалось нес колько ниже уровня гиперлактаемии, характерного для септического шока [9]. Полагаем, что это вполне закономерно, так как повышенный риск летальности могут иметь и больные без отчетливых проявлений септического шока в первые сутки нахождения в ОРИТ [27,28]. Принципиально важно, что предикторная способность в отношении летальности в проанализированных клинических наблюдениях становилась более выраженной при сочетании установленной оценки по шкале SOFA и определенного уровня лактатемии.…”