TAM visée

Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature. Leone M, Asfar P, Radermacher P, Vincent JL, Martin C. Crit Care. 2015;19(1):101. Published 2015 Mar 10. doi:10.1186/s13054-015-0794-z

Key messages

In heterogeneous populations of patients with septic shock, there is no difference in survival rates for target mean arterial pressure levels of between 65 and 85 mm Hg.

In patients with a history of arterial hypertension, a mean arterial pressure level of greater than 75 mm Hg may protect against progression to acute kidney injury.

SEPSISPAM Investigators High versus low blood-pressure target in patients with septic shock. Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, Mira JP, Dequin PF, Gergaud S, Weiss N, Legay F, Le Tulzo Y, Conrad M, Robert R, Gonzalez F, Guitton C, Tamion F, Tonnelier JM, Guezennec P, Van Der Linden T, Vieillard-Baron A, Mariotte E, Pradel G, Lesieur O, Ricard JD, Hervé F, du Cheyron D, Guerin C, Mercat A, Teboul JL, Radermacher P, N Engl J Med. 2014;370:1583–93. doi: 10.1056/NEJMoa1312173.

Conclusion: Targeting a mean arterial pressure of 80 to 85 mm Hg, as compared with 65 to 70 mm Hg, in patients with septic shock undergoing resuscitation did not result in significant differences in mortality at either 28 or 90 days.

Personalizing blood pressure management in septic shock. Kato, R., Pinsky, M.R. Ann. Intensive Care 5, 41 (2015).

Conclusion: The available evidence suggests that targeting an MAP of 65–70 mmHg in a patient with septic shock who does not have chronic hypertension is a reasonable first approximation. Whereas in a patient with chronic hypertension, targeting an MAP of 80–85 mmHg appears to be a reasonable first step. It must be done with caution, however, because the use of vasopressors is associated with adverse events.

Voie périphérique ou centrale?

Peripheral Vasopressors: Do I need that central line? Blog NU-EM

Tian DH, Smyth C, Keijzers G, Macdonald SP, Peake S, Udy A, Delaney A. Safety of peripheral administration of vasopressor medications: A systematic review. Emerg Med Australas. 2020 Apr;32(2):220-227. doi: 10.1111/1742-6723.13406. Epub 2019 Nov 7. PMID: 31698544.

Safety of peripheral intravenous administration of vasoactive medication. Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. J Hosp Med. 2015 Sep;10(9):581-5. doi: 10.1002/jhm.2394. Epub 2015 May 26. PMID: 26014852.

A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. Loubani OM, Green RS. J Crit Care. 2015 Jun;30(3):653.e9-17. doi: 10.1016/j.jcrc.2015.01.014. Epub 2015 Jan 22. PMID: 25669592.