Association between Blood Pressure after Haemodynamic Resuscitation in the Prehospital Setting and 28-Day Mortality in Septic Shock

Özet

Objective: Septic shock results in a decreased blood pressure (BP) leading to organ failure. The haemodynamic resuscitation aims at restoringthe BP to allow efficient tissue perfusion. The aim of the present study was to evaluate the association between the mean BP (MBP) reachedafter haemodynamic resuscitation in patients with septic shock cared for in the prehospital setting by a mobile intensive care unit (MICU) andmortality at 28 days after intensive care unit (ICU) admission.Methods: Patients with septic shock managed by a mobile intensive care unit (MICU) and admitted in the ICU were retrospectively analysed.The association between mortality and MBP after prehospital resuscitation was studied.Results: A total of 85 patients with septic shock were included in the study. The origin of sepsis was mainly pulmonary (64%). Mortality reached35%. Haemodynamic resuscitation was performed using crystalloids (98%) with a mean infused volume indexed on a body weight of 16±11mL kg-1 in the prehospital setting. No patient received catecholamine or antibiotic prior to hospital admission. Final prehospital MBP was 64±8mm Hg in the overall population and 66±8 mm Hg versus 62±8 mm Hg in alive and deceased patients, respectively (p=0.02). After adjustment,final prehospital MBP [odds ratio adjusted (ORa) (95% confidence interval (CI)]=0.89 (0.80–0.99), MBP 65 mmHg [ORa (95% CI)=0.06 (0.01–0.25)] were associated with mortality.Conclusion: Persistent low MBP after prehospital initial resuscitation measures in patients with septic shock managed in the prehospital settingis associated with increased mortality. Further studies are needed to evaluate the impact of prehospital haemodynamic management in septicshock to further optimise prehospital care and improve outcome.