Arterial blood pressure and heart rate regulation in shock state.

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.