• Journal of critical care · Jun 2019

    Diastolic pressure should be used to guide management of patients in shock: PRO.

    • Sheldon Magder.
    • Department of Critical Care, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec H4A 3J1, Canada.. Electronic address: sheldon.magder@mcgill.ca.
    • J Crit Care. 2019 Jun 1; 51: 241-243.

    AbstractBased primarily on the rational that adequate diastolic pressure is needed to maintain sufficient coronary blood for myocardial needs, diastolic pressure has been proposed as a treatment target for patients in shock. To date, clinical evidence supporting this is limited to observational data. Key points are that what is important for tissues is flow not pressure; the coronary circulation has very large flow reserves and can maintain flow with a low pressure; raising arterial pressure by only increasing vascular resistance does not alter tissue perfusion and could even increase myocardial oxygen demand. Targeting diastolic pressure can lead to over use of vasopressors, which studies have associated with worse outcome. Pressor management in shock should include assessment of indicators of tissue perfusion and changes in flow if possible.Copyright © 2018. Published by Elsevier Inc.

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