From the Guidelines
Sepsis causes wide pulse pressure primarily due to the systemic inflammatory response that leads to vasodilation and decreased vascular resistance. This is evident from the pathophysiological changes that occur in sepsis, where bacterial toxins and inflammatory mediators like cytokines trigger excessive nitric oxide production, causing profound peripheral vasodilation 1. The key recommendations for managing sepsis, as outlined in the surviving sepsis campaign, include early quantitative resuscitation and administration of broad-spectrum antimicrobials therapy within 1 h of recognition of septic shock 1. Some key points to consider in the management of sepsis include:
- Early fluid resuscitation with crystalloid and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure 1
- Norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg 1
- Avoidance of hetastarch formulations and dopamine except in highly selected circumstances 1 The combination of relatively preserved systolic pressure with a markedly decreased diastolic pressure results in a widened pulse pressure, which is characteristic of the hyperdynamic or "warm" phase of septic shock. As sepsis progresses, myocardial depression may develop, potentially leading to decreased cardiac output and narrowing of pulse pressure in later stages. The wide pulse pressure in early sepsis is an important clinical sign that reflects the underlying pathophysiological changes in the cardiovascular system during the septic response, and its management is crucial to improve patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Sepsis and Pulse Pressure
- Sepsis is a life-threatening condition that can cause a wide range of symptoms, including changes in blood pressure 2.
- Pulse pressure, which is the difference between systolic and diastolic blood pressure, can be affected in patients with sepsis 2, 3.
Causes of Wide Pulse Pressure in Sepsis
- The exact cause of wide pulse pressure in sepsis is not fully understood, but it may be related to the body's response to infection and inflammation 2.
- Studies have shown that patients with sepsis who have a wider pulse pressure may have a higher risk of mortality 2, 3.
- One study found that a pulse pressure greater than 70 mmHg was associated with a lower mortality rate in patients with sepsis 2.
- Another study found that a higher pulse pressure was independently associated with 28-day mortality in patients with septic shock 3.
Mechanisms Underlying Wide Pulse Pressure in Sepsis
- The mechanisms underlying wide pulse pressure in sepsis are complex and may involve changes in vascular tone, cardiac function, and fluid status 3.
- Further studies are needed to fully understand the causes and consequences of wide pulse pressure in sepsis 3, 4.
- The use of antibiotics, such as meropenem and piperacillin-tazobactam, may also play a role in the management of sepsis and the prevention of wide pulse pressure 5, 4, 6.