Effect of Increasing Blood Pressure With Noradrenaline on the Microcirculation of Patients With Septic Shock and Previous Arterial Hypertension.

ABSTRACT

OBJECTIVES: To assess whether an increase in mean arterial pressure in patients with septic shock and previous systemic arterial hypertension changes microcirculatory and systemic hemodynamic variables compared with patients without arterial hypertension (control). DESIGN: Prospective, nonblinded, interventional study. SETTING: Three ICUs in two teaching hospitals. PATIENTS After informed consent, we included patients older than 18 years with septic shock for at least 6 hours, sedated, and under mechanical ventilation. We paired patients with and without arterial hypertension by age. INTERVENTIONS: After obtaining systemic and microcirculation baseline hemodynamic variables (time 0), we increased noradrenaline dose to elevate mean arterial pressure up to 85-90 mm Hg before collecting a new set of measurements (time 1). MEASUREMENTS AND MAIN RESULTS: We included 40 patients (20 in each group). There was no significant difference in age between the groups. After the rise in mean arterial pressure, there was a significant increase in cardiac index and a slight but significant reduction in lactate in both groups. We observed a significant improvement in the proportion of perfused vessels (control 57.2 ± 14% to 66 ± 14.8%; arterial hypertension 61.4 ± 12.3% to 70.8 ± 7.1%; groups p = 0.29; T0 and T1 p < 0.001; group and time interaction p = 0.85); perfused vessels density (control 15.6 ± 4 mm/mm to 18.6 ± 4.5 mm/mm; arterial hypertension 16.4 ± 3.5 mm/mm to 19.1 ± 3 mm/mm; groups p = 0.51; T0 and T1 p < 0.001; group and time interaction p = 0.70), and microcirculatory flow index (control 2.1 ± 0.6 to 2.4 ± 0.6; arterial hypertension 2.1 ± 0.5 to 2.6 ± 0.2; groups p = 0.71; T0 and T1 p = 0.002; group and time interaction p = 0.45) in both groups. CONCLUSIONS: Increasing mean arterial pressure with noradrenaline in septic shock patients improves density and flow in small vessels of sublingual microcirculation. However, this improvement occurs both in patients with previous arterial hypertension and in those without arterial hypertension.