Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database

Abstract

BackgroundMaintenance of mean arterial pressure (MAP) at levels sufficient to avoid tissue hypoperfusion is a key tenet in the management of distributive shock. We hypothesized that patients with distributive shock sometimes have a MAP below that typically recommended and that such hypotension is associated with increased mortality.MethodsIn this retrospective analysis of the Medical Information Mart for Intensive Care (MIMIC-III) database from Beth Israel Deaconess Medical Center, Boston, USA, we included all intensive care unit (ICU) admissions between 2001 and 2012 with distributive shock, defined as continuous vasopressor support for ≥ 6 h and no evidence of low cardiac output shock. Hypotension was evaluated using five MAP thresholds: 80, 75, 65, 60 and 55 mmHg. We evaluated the longest continuous episode below each threshold during vasopressor therapy. The primary outcome was ICU mortality.ResultsOf 5347 patients with distributive shock, 95.7%, 91.0%, 62.0%, 36.0% and 17.2%, respectively, had MAP < 80, < 75, < 65, < 60 and < 55 mmHg for more than two consecutive hours. On average, ICU mortality increased by 1.3, 1.8, 5.1, 7.9 and 14.4 percentage points for each additional 2 h with MAP < 80, < 75, < 65, < 60 and < 55 mmHg, respectively. Multivariable logistic modeling showed that, compared to patients in whom MAP was never < 65 mmHg, ICU mortality increased as duration of hypotension < 65 mmHg increased [for > 0 to < 2 h, odds ratio (OR) 1.76, p = 0.005; ≥ 6 to < 8 h, OR 2.90, p < 0.0001; ≥ 20 h, OR 7.10, p < 0.0001]. When hypotension was defined as MAP < 60 or < 55 mmHg, the associations between duration and mortality were generally stronger than when hypotension was defined as MAP < 65 mmHg. There was no association between hypotension and mortality when hypotension was defined as MAP < 80 mmHg.ConclusionsWithin the limitations due to the nature of the study, most patients with distributive shock experienced at least one episode with MAP < 65 mmHg lasting > 2 h. Episodes of prolonged hypotension were associated with higher mortality.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0448-9) contains supplementary material, which is available to authorized users.

Mean arterial pressure within 24 hours of admission predicts short-term prognosis in patients with intermediate-risk and high-risk pulmonary embolism

“…MAP is determined as 1/3 Systolic BP plus 2/3 Diastolic BP.The evaluation of MAP has turned out to improve the outcome in different life-threatening illness as sepsis resuscitation, ischemic stroke and distributive shock [15] .Moreover,MAP fluctuations between − 5% and 5% were significantly related to ICU mortality (odds ratio, 1.296; 95% CI, 1.103-1.521; p = 0.002) and hospital mortality (odds ratio, 1.323; 95% CI, 1.142-1.531; p < 0.001) [16] . Consequently,MAP may be a better indicator that reflects the hemodynamics profile than Systolic BP.…”

The Predictive Value of MAP and ETCO2 Changes After Emergency Endotracheal Intubation for Severe Cardiovascular Collapse

“…This long-term average blood pressure of less than 65 mmHg will lead to the hypoperfusion of vital organs, and persistent hypotension is associated with higher mortality [13]. When coronary perfusion pressure drops severely, leading to insu cient blood and oxygen supply to the heart, even the most serious complication of cardiac arrest may occur [14].…”

Mean arterial pressure within 24 hours of admission predicts short-term prognosis in patients with intermediate-risk and high-risk pulmonary embolism

“…MAP was determined as 1/3 systolic BP plus 2/3 diastolic BP. The evaluation of MAP has turned out to improve the outcome in different life-threatening illnesses, such as sepsis resuscitation, ischemic stroke and distributive shock [15] . Moreover, MAP fluctuations between − 5% and 5% were significantly related to ICU mortality (odds ratio, 1.296; 95% CI, 1.103-1.521; p = 0.002) and hospital mortality (odds ratio, 1.323; 95% CI, 1.142-1.531; p < 0.001) [16] .…”