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Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy

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Author(s)
Sang-Hun Lee Youn-Jung Kim Gi Na Yu Jae Cheon Jeon Won Young Kim 
Keimyung Author(s)
Lee, Sang HunJeon, Jae Cheon
Department
Dept. of Emergency Medicine (응급의학)
Journal Title
Korean J Intern Med
Issued Date
2021
Volume
36
Issue
4
Keyword
Septic shockBlood pressurePrognosisEmergenciesCritical care
Abstract
Background/aims:
Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality.

Methods:
Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality.

Results:
Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality.

Conclusions:
PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.
Keimyung Author(s)(Kor)
이상훈
전재천
Publisher
School of Medicine (의과대학)
Citation
Sang-Hun Lee et al. (2021). Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy. Korean J Intern Med, 36(4), 924–931. doi: 10.3904/kjim.2020.056
Type
Article
ISSN
2005-6648
Source
https://www.kjim.org/journal/view.php?doi=10.3904/kjim.2020.056
DOI
10.3904/kjim.2020.056
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43558
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학)
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