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Vasopressors and Mean Arterial Pressure in Septic Shock: Do We Bend the Rules for Young Adults?
Amit Frenkel1, Ran Abuhasira2, Lior Fisher3
1General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Clinical teams may target higher mean arterial pressure (MAP) in younger septic shock patients. This retrospective study found younger patients received more aggressive noradrenaline treatment, despite uniform MAP goals.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
- Clinical Pharmacology
Background:
- Younger patients with septic shock in the ICU may motivate caregivers.
- Previous studies suggest age influences treatment intensity.
Purpose of the Study:
- To investigate if clinical teams aim for higher mean arterial pressure (MAP) in younger patients with septic shock.
- To examine age-based variations in noradrenaline titration.
Main Methods:
- Retrospective population-based cohort study (2006-2018) of 555 septic shock patients treated with noradrenaline.
- Patients categorized into four age groups: 18-45, 46-60, 61-75, and >75 years.
- Adjusted linear mixed models and LOWESS curves analyzed age's association with MAP and noradrenaline dosage.
Main Results:
- An inverse relationship was found between average MAP and patient age.
- Younger patients (18-45 years) had an average MAP 4.7 mmHg higher than older patients (>75 years) (P<0.001).
- This difference persisted after adjusting for sex, ICU mortality, and SOFA scores.
Conclusions:
- Noradrenaline titration in septic shock patients resulted in higher average MAP for younger individuals.
- Healthcare staff may unconsciously use higher MAP targets for younger patients.
- Evidence does not support age-based differential MAP targets in septic shock management.
Background:
Younger patient age and relatively good prognosis have been described as factors that may increase caregiver motivation in treating patients with septic shock in the intensive care unit (ICU).
Objectives:
To examine whether clinical teams tended to achieve unnecessarily higher map arterial pressure (MAP) values in younger patients.
Methods:
We conducted a population-based retrospective cohort study of patients presenting with septic shock who were treated with noradrenaline and hospitalized in a general ICU between 2006 and 2018. The patients were classified into four age groups: 18-45 (n=129), 46-60 (n=96), 61-75 (n=157), and older than 75 years (n=173). Adjusted linear mixed models and locally weighted scatterplot smoothing (LOWESS) curves were used to assess associations and potential non-linear relationships, respectively, of age group with MAP and noradrenaline dosage.
Results:
The cohort included 555 patients. An inverse relation was observed between average MAP value and age. Among patients aged 18-45 years, the average MAP was 4.7 mmHg higher (95% confidence interval 3.4-5.9) than among patients aged > 75 years (P-value <0.001) after adjustment for sex, death in the intensive care unit, and Sequential Organ Failure Assessment scores.
Conclusions:
Among patients with septic shock, the titration of noradrenaline by staff led to a higher average MAP for younger patients. Although the MAP target is equal for all age groups, staff may administer noradrenaline treatment according to a higher target of MAP due to attitudes toward patients of different ages, despite any evidence that such practice is beneficial.
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