Arterial blood pressure and heart rate regulation in shock state. Issue 5 (October 2015)

• Record Type: Journal Article
• Authors: DellaVolpe, Jeffrey D.; Moore, Jason E.; Pinsky, Michael R.
• Is Part Of: Current opinion in critical care. Volume 21:Issue 5(2015:Oct.)
• Publication Date: 2015-10
• Subjects: blood pressure -- heart rate -- shock -- tachycardia; Critical care medicine -- Periodicals; 616.028
• DOI: 10.1097/MCC.0000000000000239
• Languages: English
• ISSNs: 1070-5295

Abstract

Abstract : 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.