Key result
Targeting a higher mean arterial pressure (>70 mmHg) did not significantly reduce all-cause mortality compared to a lower target (60-70 mmHg) in critically ill patients with vasodilatory shock (RR 1.06).
Why the study?
While guidelines recommend an initial MAP of 65 mmHg in septic shock, the optimal MAP target for improving outcomes remains controversial.
Does a higher MAP target (>70 mmHg) reduce all-cause mortality in critically ill adult patients with vasodilatory shock compared to a lower MAP target (60-70 mmHg)?
Meta-Analysis (n=3,357)
Open-label
Randomized
Yes
Does a higher MAP target (>70 mmHg) reduce all-cause mortality in critically ill adult patients with vasodilatory shock compared to a lower MAP target (60-70 mmHg)?
Effect estimate: RR 1.06 (95% CI 0.98-1.16)
Absolute Event Rate: 40.3% vs 37.9%
Targeting a higher mean arterial pressure (>70 mmHg) in critically ill patients with vasodilatory shock does not improve mortality but increases the risk of supraventricular arrhythmias, though it may reduce the need for renal replacement therapy in patients with chronic hypertension.
Supports lower MAP targets in vasodilatory shock; confirms no mortality benefit from higher targets.
While the Surviving Sepsis Campaign guidelines recommend an initial target value of 65 mmHg as the mean arterial pressure (MAP) in patients with septic shock, the optimal MAP target for improving outcomes remains controversial. We performed a meta-analysis to evaluate the optimal MAP for patients with vasodilatory shock, which included three randomized controlled trials that recruited 3,357 patients. Between the lower (60–70 mmHg) and higher (>70 mmHg) MAP target groups, there was no significant difference in all-cause mortality (risk ratio [RR], 1.06; 95% confidence intervals [CI], 0.98–1.16) which was similar in patients with chronic hypertension (RR, 1.10; 95% CI, 0.98–1.24) and patients aged ≥65 years (RR, 1.10; 95% CI, 0.99–1.21). No significant difference in adverse events was observed between the different MAP groups (RR, 1.04; 95% CI, 0.87–1.24); however, supraventricular arrhythmia was significantly higher in the higher MAP group (RR, 1.73; 95% CI, 1.15–2.60). Renal replacement therapy was reduced in the higher MAP group of patients with chronic hypertension (RR, 0.83; 95% CI, 0.71–0.98). Though the higher MAP control did not improve the mortality rate, it may be beneficial in reducing renal replacement therapy in patients with chronic hypertension. Systematic review registration: UMIN Clinical Trials Registry, identifier UMIN000042624
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Yoshimoto et al. (2022) conducted a meta-analysis in Vasodilatory shock (n=3,357). Higher MAP target vs. Lower MAP target (60-70 mmHg) was evaluated on All-cause mortality (closest to 28 days) (RR 1.06, 95% CI 0.98-1.16). Targeting a higher mean arterial pressure (>70 mmHg) did not significantly reduce all-cause mortality compared to a lower target (60-70 mmHg) in critically ill patients with vasodilatory shock (RR 1.06).
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