Blood pressure target in anaesthesia and intensive care
Résumé
Blood pressure is subject to constant autoregulation in order to maintain values that are ``adapted `` to the body's needs. This depends on different mechanisms acting at different levels and in different time frames. The blood pressure targets are varied due to the patient's condition, the type of surgery considered in anaesthesia and the aetiology of shock in intensive care. In non-cardiac surgery, an ``absolute `` threshold of MAP lower than 60-70 mmHg, SAP lower than 90 mmHg and higher than 160 mmHg would be associated with postoperative complications. The individualisation of blood pressure objectives by targeting a preoperative reference value seems to be a relevant practice from a pathophysiological point of view but needs to be further studied. In cardiac surgery, it does not seem appropriate to maintain a high MAP target during extracorporeal circulation, while not exceeding a SAP of 140 mmHg. During cardiogenic shock, evidences allow us to position ourselves on an early use of catecholamines with a target MAP > 70 mmHg. During septic shock, it is advisable to target a MAP > 65 mmHg according to the latest recommendations. During haemorrhagic shock, fluid resuscitation should be limited with early use of vasopressors if necessary in case of threatening arterial hypotension (SAP < 80 mmHg and/or MAP < 60 mmHg). In cases of severe traumatic brain injury, a cerebral perfusion pressure higher than 60-70 mmHg should be maintained.