Vasopressors and Mean Arterial Pressure in Septic Shock: Do We Bend the Rules for Young Adults?

Amit Frenkel, Ran Abuhasira, Lior Fisher, Yoav Bichovsky, Alexander Zlotnik, Victor Novack, Moti Klein

    Research output: Contribution to journalArticlepeer-review


    Background: Younger 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). Objectives: To examine whether clinical teams tended to achieve unnecessarily higher map arterial pressure (MAP) values in younger patients. Methods: We 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. Results: The 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. Conclusions: Among 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.

    Original languageEnglish
    Pages (from-to)741-746
    Number of pages6
    JournalIsrael Medical Association Journal
    Issue number11
    StatePublished - 1 Jan 2023


    • elderly
    • intensive care unit
    • mean arterial pressure
    • noradrenaline septic shock

    ASJC Scopus subject areas

    • General Medicine


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