Should we treat mild hypotension in septic patients in the absence of peripheral tissue hypoperfusion?

International audienceIn sepsis patients, international guidelines recommend to maintain a mean arterial blood pressure higher than 65 mmHg and in hypertensive patients higher than 75 mmHg. In a recent issue of Intensive Care Medicine, Maheshwari et al. retrospectively analyzed a large database in the USA and reported that both mortality and acute kidney failure increased when mean arterial blood pressure (MAP) decreased. The evidence for clearly defining mean blood targets to optimize tissue perfusion in septic patients remains controversial. During the last two decades, several groups have reported the strong predictive value of microcirculatory disorders and tissue hypoperfusion in septic shock patients. Furthermore, variable impact of arterial hypotension on microcirculatory blood flow and tissue perfusion has been reported. Indeed, in sepsis patients with comparable MAP, tissue perfusion could be altered or preserved, suggesting that a “universal MAP target” is probably not the right direction. We believe that tissue perfusion analysis could be helpful to guide MAP target. Here, we report that mild arterial hypotension could be tolerated in septic patients in the absence of tissue hypoperfusion