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Increasing mean arterial blood pressure in sepsis: effects on fluid balance, vasopressor load and renal function

机译：脓毒症的平均动脉血压升高：对体液平衡，升压药负荷和肾功能的影响

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IntroductionThe objective of this study was to evaluate the effects of two different mean arterial blood pressure (MAP) targets on needs for resuscitation, organ dysfunction, mitochondrial respiration and inflammatory response in a long-term model of fecal peritonitis.MethodsTwenty-four anesthetized and mechanically ventilated pigs were randomly assigned (n = 8/group) to a septic control group (septic-CG) without resuscitation until death or one of two groups with resuscitation performed after 12 hours of untreated sepsis for 48 hours, targeting MAP 50-60 mmHg (low-MAP) or 75-85 mmHg (high-MAP).ResultsMAP at the end of resuscitation was 56 ± 13 mmHg (mean ± SD) and 76 ± 17 mmHg respectively, for low-MAP and high-MAP groups. One animal each in high- and low-MAP groups, and all animals in septic-CG died (median survival time: 21.8 hours, inter-quartile range: 16.3-27.5 hours). Norepinephrine was administered to all animals of the high-MAP group (0.38 (0.21-0.56) mcg/kg/min), and to three animals of the low-MAP group (0.00 (0.00-0.25) mcg/kg/min; P = 0.009). The high-MAP group had a more positive fluid balance (3.3 ± 1.0 mL/kg/h vs. 2.3 ± 0.7 mL/kg/h; P = 0.001). Inflammatory markers, skeletal muscle ATP content and hemodynamics other than MAP did not differ between low- and high-MAP groups. The incidence of acute kidney injury (AKI) after 12 hours of untreated sepsis was, respectively for low- and high-MAP groups, 50% (4/8) and 38% (3/8), and in the end of the study 57% (4/7) and 0% (P = 0.026). In septic-CG, maximal isolated skeletal muscle mitochondrial Complex I, State 3 respiration increased from 1357 ± 149 pmol/s/mg to 1822 ± 385 pmol/s/mg, (P = 0.020). In high- and low-MAP groups, permeabilized skeletal muscle fibers Complex IV-state 3 respiration increased during resuscitation (P = 0.003).ConclusionsThe MAP targets during resuscitation did not alter the inflammatory response, nor affected skeletal muscle ATP content and mitochondrial respiration. While targeting a lower MAP was associated with increased incidence of AKI, targeting a higher MAP resulted in increased net positive fluid balance and vasopressor load during resuscitation. The long-term effects of different MAP targets need to be evaluated in further studies.
机译：前言本研究的目的是评估粪便性腹膜炎的长期模型中两种不同的平均动脉血压（MAP）指标对复苏需求，器官功能障碍，线粒体呼吸和炎症反应的影响。方法二十四麻醉和机械麻醉通风的猪被随机分配（每组8只）至未进行复苏的脓毒症对照组（septic-CG），直至死亡或未经治疗的脓毒症12小时（48小时）后进行复苏的两组，以MAP 50-60 mmHg为目标（低MAP）或75-85 mmHg（高MAP）。对于低MAP和高MAP组，复苏结束时的MAP分别为56±13 mmHg（平均±SD）和76±17 mmHg。高和低MAP组各有1只动物，败血性CG组的所有动物均死亡（中位生存时间：21.8小时，四分位间距：16.3-27.5小时）。对高MAP组的所有动物（0.38（0.21-0.56）mcg / kg / min）和低MAP组的三只动物（0.00（0.00-0.25）mcg / kg / min）给予去甲肾上腺素; P = 0.009）。高MAP组的体液平衡更高（3.3±1.0 mL / kg / h与2.3±0.7 mL / kg / h; P = 0.001）。低MAP组和高MAP组之间的炎性标志物，骨骼肌ATP含量和除MAP以外的血液动力学无差异。在低和高MAP组，未经治疗的脓毒症12小时后的急性肾损伤（AKI）发生率分别为50％（4/8）和38％（3/8），并且在研究结束时57％（4/7）和0％（P = 0.026）。在败血性CG中，最大的孤立骨骼肌线粒体复合体I的状态3呼吸从1357±149 pmol / s / mg增加到1822±385 pmol / s / mg（P = 0.020）。在高和低MAP组中，复苏过程中透化的骨骼肌纤维复合物IV状态3呼吸增加（P = 0.003）。虽然针对较低的MAP与AKI的发生率增加相关，但针对较高的MAP则导致复苏过程中净净体液平衡和升压药负荷增加。需要在进一步研究中评估不同MAP目标的长期影响。

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