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Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database

Author

Listed:
  • Jean Louis Vincent
  • Nathan N.D. Nielsen
  • Nathan N.I. Shapiro
  • Margaret M.E. Gerbasi
  • Aaron Grossman
  • Robin Doroff
  • Feng Zeng
  • Paul M. Young
  • James Russell

Abstract

Background: Maintenance of mean arterial pressure (MAP) at levels sufficient to avoid tissue hypoperfusion is a key tenet in the management of distributive shock. We hypothesized that patients with distributive shock sometimes have a MAP below that typically recommended and that such hypotension is associated with increased mortality. Methods: In this retrospective analysis of the Medical Information Mart for Intensive Care (MIMIC-III) database from Beth Israel Deaconess Medical Center, Boston, USA, we included all intensive care unit (ICU) admissions between 2001 and 2012 with distributive shock, defined as continuous vasopressor support for ≥ 6 h and no evidence of low cardiac output shock. Hypotension was evaluated using five MAP thresholds: 80, 75, 65, 60 and 55 mmHg. We evaluated the longest continuous episode below each threshold during vasopressor therapy. The primary outcome was ICU mortality. Results: Of 5347 patients with distributive shock, 95.7%, 91.0%, 62.0%, 36.0% and 17.2%, respectively, had MAP 0 to 2 h. Episodes of prolonged hypotension were associated with higher mortality.

Suggested Citation

  • Jean Louis Vincent & Nathan N.D. Nielsen & Nathan N.I. Shapiro & Margaret M.E. Gerbasi & Aaron Grossman & Robin Doroff & Feng Zeng & Paul M. Young & James Russell, 2018. "Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database," ULB Institutional Repository 2013/283472, ULB -- Universite Libre de Bruxelles.
    • Handle: RePEc:ulb:ulbeco:2013/283472
    Note: SCOPUS: ar.j
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