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Septic Shock and Vasopressor Therapy
Barbara Clark Mims
其他書名
The Impact of Excessive Mean Arterial Pressure Values
出版Catholic University of America. 2022., 2022
URLhttp://books.google.com.hk/books?id=sZQbzwEACAAJ&hl=&source=gbs_api
註釋Septic Shock and Vasopressor Therapy: The Impact of Excessive Mean Arterial Pressure Values Barbara Clark Mims, PhD Director: Nalini Jairath, PhD, MSc.N., RN Abstract Septic shock consists of circulatory failure secondary to infection. During septic shock, mediator-induced vasodilation causes hypotension, requiring vasopressor therapy to restore vascular tone and hemodynamic stability. While life-sustaining, vasopressors may cause harm, especially when delivered at higher doses. Regulatory standards require providers' orders to include a maximum dose and a titration target, which usually consists of a mean arterial pressure (MAP) value. However, a maximum MAP value is neither required nor routinely ordered. This leaves the nurse with discretion regarding the dose delivered and MAP value maintained. For almost two decades, a MAP target value of 9́Æ 65mmHg has prevailed. However, actual MAP values often substantially exceed ordered target values. Controversy exists regarding the ideal MAP target value, but achieving higher MAP values clearly requires higher vasopressor doses. Problem. During vasopressor therapy for patients in septic shock, actual MAP values often exceed the recommended titration target of 65 mmHg and may contribute to adverse outcomes. Research Method. This retrospective, correlational, longitudinal study used the Medical Information Mart for Critical Care (MIMIC-III) database to obtain a sample of 188 critically ill adults diagnosed with septic shock. Detailed, deidentified patient records provided the data. Poisson regression and the Cox proportional hazards model tested six hypotheses exploring relationships between excessive MAP values and adverse outcomes. Results. The duration of vasopressor exposure, mechanical ventilation, ICU stay, and hospital stay all increased with higher MAP values (p