# Personalizing blood pressure management in septic shock

## TL;DR

This review discusses how blood pressure targets should be personalized in septic shock patients to optimize organ perfusion and avoid complications.

## Contribution

The paper highlights the need to move beyond a single MAP target and consider organ-specific perfusion pressures in septic shock management.

## Key findings

- A MAP of 65–70 mmHg is reasonable for non-hypertensive septic shock patients.
- Higher MAP targets (80–85 mmHg) may be needed for patients with chronic hypertension to prevent kidney injury.
- Organ-specific perfusion pressures should guide blood pressure management after initial MAP targets are achieved.

## Abstract

This review examines the available evidence for targeting a specific mean arterial pressure (MAP) in sepsis resuscitation. The clinical data suggest that targeting an MAP of 65–70 mmHg in patients with septic shock who do not have chronic hypertension is a reasonable first approximation. Whereas in patients with chronic hypertension, targeting a higher MAP of 80–85 mmHg minimizes renal injury, but it comes with increased risk of arrhythmias. Importantly, MAP alone should not be used as a surrogate of organ perfusion pressure, especially under conditions in which intracranial, intra-abdominal or tissue pressures may be elevated. Organ-specific perfusion pressure targets include 50–70 mmHg for the brain based on trauma brain injury as a surrogate for sepsis, 65 mmHg for renal perfusion and >50 mmHg for hepato-splanchnic flow. Even at the same MAP, organs and regions within organs may have different perfusion pressure and pressure–flow relationships. Thus, once this initial MAP target is achieved, MAP should be titrated up or down based on the measures of organ function and tissue perfusion.