Prehospital pulse pressure and mortality of septic shock patients cared for by a mobile intensive care unit

BMC Emergency Medicine

Research

Vincent Bounes¹  Basile Gilbert¹  Papa Gueye²  Emmanuel Bloch-Laine³  Romain Jouffroy⁴  Benoit Vivien⁵  Patrick Ecollan⁶  Jean Pierre Tourtier⁷  Josiane Boularan⁸ 

[1]Department of Emergency Medicine, SAMU 31, University Hospital of Toulouse, Toulouse, France

[2]EA 7525 Université des Antilles, Fort de France, France

[3]SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France

[4]EA 7525 University of the Antilles, Martinique, France

[5]Emergency Department, Cochin Hospital, Paris, France

[6]Emergency Department, SMUR, Hôtel Dieu Hospital - Assistance Publique - Hôpitaux Paris, Paris, France

[7]Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique Hôpitaux Paris and Paris Saclay University, 9 avenue Charles De Gaulle, 92100, Boulogne-Billancourt, France

[8]Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux Paris, Paris, France

[9]Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM, Paris Saclay University, Villejuif, France

[10]Institut de Recherche bioMédicale et d’Epidémiologie du Sport - EA7329, INSEP - Paris University, Paris, France

[11]EA 7525 Université des Antilles, Fort de France, France

[12]Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux Paris, Paris, France

[13]Intensive Care Unit, SMUR, Pitie Salpêtriere Hospital, 47 Boulevard de l’Hôpital, Paris - Assistance Publique - Hôpitaux Paris, 75013, Paris, France

[14]Paris Fire Brigade, Paris, France

[15]SAMU 31, Centre Hospitalier Intercommunal Castres-Mazamet, Castres, France

关键词: Septic shock;    Pulse pressure;    Cardiac output;    Prehospital setting;    Association;   

DOI  :  10.1186/s12873-023-00864-0

 received in 2023-03-20, accepted in 2023-08-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSeptic shock medical treatment relies on a bundle of care including antibiotic therapy and hemodynamic optimisation. Hemodynamic optimisation consists of fluid expansion and norepinephrine administration aiming to optimise cardiac output to reach a mean arterial pressure of 65mmHg. In the prehospital setting, direct cardiac output assessment is difficult because of the lack of invasive and non-invasive devices. This study aims to assess the relationship between 30-day mortality and (i) initial pulse pressure (iPP) as (ii) pulse pressure variation (dPP) during the prehospital stage among patients cared for SS by a prehospital mobile intensive care unit (MICU).MethodsFrom May 09th, 2016 to December 02nd, 2021, septic shock patients requiring MICU intervention were retrospectively analysed. iPP was calculated as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the first contact between the patient and the MICU team prior to any treatment and, dPP as the difference between the final PP (the difference between SBP and DBP at the end of the prehospital stage) and iPP divided by prehospital duration. To consider cofounders, the propensity score method was used to assess the relationship between (i) iPP < 40mmHg, (ii) positive dPP and 30-day mortality.ResultsAmong the 530 patients analysed, pulmonary, digestive, and urinary infections were suspected among 43%, 25% and 17% patients, respectively. The 30-day overall mortality rate reached 31%. Cox regression analysis showed an association between 30-day mortality and (i) iPP < 40mmHg; aHR of 1.61 [1.03–2.51], and (ii) a positive dPP; aHR of 0.56 [0.36–0.88].ConclusionThe current study reports an association between 30-day mortality rate and iPP < 40mmHg and a positive dPP among septic shock patients cared for by a prehospital MICU. A negative dPP could be helpful to identify septic shock with higher risk of poor outcome despite prehospital hemodynamic optimization.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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