• Amit Frenkel, Ran Abuhasira, Lior Fisher, Yoav Bichovsky, Alexander Zlotnik, Victor Novack, and Moti Klein.
• General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
• Isr Med Assoc J. 2023 Nov 1; 25 (11): 741746741-746.

BackgroundYounger patient age and relatively good prognosis have been described as factors that may increase caregiver motivation in treating patients with septic shock in the intensive care unit (ICU).ObjectivesTo examine whether clinical teams tended to achieve unnecessarily higher map arterial pressure (MAP) values in younger patients.MethodsWe conducted a population-based retrospective cohort study of patients presenting with septic shock who were treated with noradrenaline and hospitalized in a general ICU between 2006 and 2018. The patients were classified into four age groups: 18-45 (n=129), 46-60 (n=96), 61-75 (n=157), and older than 75 years (n=173). Adjusted linear mixed models and locally weighted scatterplot smoothing (LOWESS) curves were used to assess associations and potential non-linear relationships, respectively, of age group with MAP and noradrenaline dosage.ResultsThe cohort included 555 patients. An inverse relation was observed between average MAP value and age. Among patients aged 18-45 years, the average MAP was 4.7 mmHg higher (95% confidence interval 3.4-5.9) than among patients aged > 75 years (P-value <0.001) after adjustment for sex, death in the intensive care unit, and Sequential Organ Failure Assessment scores.ConclusionsAmong patients with septic shock, the titration of noradrenaline by staff led to a higher average MAP for younger patients. Although the MAP target is equal for all age groups, staff may administer noradrenaline treatment according to a higher target of MAP due to attitudes toward patients of different ages, despite any evidence that such practice is beneficial.

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