2nd May 2014 The SEPSISPAM trial

Presented by Dr Poppy Aldam

This week we will discuss a recent <a style="color: #ae4b33;" title="SEPSISPAM" href="https://www.dropbox.com/s/fnqm6tf4etais5v/High%20versus%20Low%20Blood-Pressure%20Target%20%20in%20Patients%20with%20Septic%20Shock more info here.pdf” target=”_blank”>paper which in some ways complements the ProCESS trial and other similar studies examining protocol based approaches to the management of sepsis.

There has been persistent uncertainty about whether septic patients with a background of hypertension or atherosclerosis require a higher MAP during treatment for vasopressor dependent shock. This study attempted to address this question by asking whether a strategy of higher MAP improved a range of outcomes compared to the Surviving Sepsis guideline pressure of 65 mmHg.

There are some interesting points if we have time for discussion, for example the incidence of adverse cardiac events increased in the high pressure group whilst the incidence of renal failure was lower in the higher pressure group, is it good to avoid CVVHDF if it gives you an MI or stroke?

How should we achieve the higher pressure in hypertesive patients? We only really have fluids or vasopresors and we would need both but what proportions?

How does this study fit with the recent debate about β-blockers in sepsis and strategies to reduce the sympathetic stress on the cardiovascular system?

Here are some editorials and so on:

The accompanying editorial in the NEJM

Medscape article

PulmCCM Blog

Also have a look at the supplementary material here

Next week we will be discussing a complicated study looking at the interaction between steroids and vasopressin.