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JOURNAL ARTICLE
RESEARCH SUPPORT, N.I.H., EXTRAMURAL
REVIEW
Arterial blood pressure and heart rate regulation in shock state.
Current Opinion in Critical Care 2015 October
PURPOSE OF REVIEW: Circulatory shock is a complicated problem that carries a high risk of complications and mortality for critically ill patients. The heart rate and blood pressure targets to which a patient in shock should be resuscitated remain a challenge to intensivists.
RECENT FINDINGS: While the ideal blood pressure and heart rate in circulatory shock are still not definitive, recent studies have begun to refine these targets. A recent trial comparing a mean arterial pressure target of 80-85 mmHg with a target of 65-70 mmHg showed no difference in mortality, with a decreased need for renal replacement therapy in patients with pre-existing hypertension based on subgroup analysis. Regulation of heart rate was defined by a trial demonstrating that heart rate control in patients with severe sepsis on high-dose norepinephrine with esmolol titration did not result in additional adverse events.
SUMMARY: The ideal target blood pressure in the resuscitation of circulatory shock is variable and likely depends on prior blood pressure. Heart rate regulation with β-blockade appears to be safe in selected patients when accompanied by adequate resuscitation and monitoring.
RECENT FINDINGS: While the ideal blood pressure and heart rate in circulatory shock are still not definitive, recent studies have begun to refine these targets. A recent trial comparing a mean arterial pressure target of 80-85 mmHg with a target of 65-70 mmHg showed no difference in mortality, with a decreased need for renal replacement therapy in patients with pre-existing hypertension based on subgroup analysis. Regulation of heart rate was defined by a trial demonstrating that heart rate control in patients with severe sepsis on high-dose norepinephrine with esmolol titration did not result in additional adverse events.
SUMMARY: The ideal target blood pressure in the resuscitation of circulatory shock is variable and likely depends on prior blood pressure. Heart rate regulation with β-blockade appears to be safe in selected patients when accompanied by adequate resuscitation and monitoring.
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