Key result
A higher mean arterial pressure target (>70 mmHg) did not 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 mean arterial pressure target of 65 mmHg in septic shock, the optimal target for improving outcomes remains controversial.
Does a higher MAP target (>70 mmHg) reduce all-cause mortality compared to a lower MAP target (60-70 mmHg) in critically ill adult patients with vasodilatory shock?
Meta-Analysis (n=3,357)
Open-label
Yes
Does a higher MAP target (>70 mmHg) reduce all-cause mortality compared to a lower MAP target (60-70 mmHg) in critically ill adult patients with vasodilatory shock?
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) does not improve mortality in vasodilatory shock but increases the risk of supraventricular arrhythmias, though it may reduce the need for renal replacement therapy in patients with chronic hypertension.
No mortality benefit from higher MAP targets; confirms lower targets (60-70 mmHg) as sufficient in vasodilatory shock.
While the Surviving Sepsis Campaign guidelines recommend an initial target value of 65 mmHg of mean arterial pressure (MAP) in patients with septic shock, the optimal MAP target for improving outcomes remains controversial. A meta-analysis to evaluate the optimal MAP for patients with vasodilatory shock, which included 3 randomized controlled trials and recruited 3,357 patients. Between the lower (60-70 mmHg) and the higher (over 70 mmHg) MAP target groups, there was no significant difference in all-cause mortality (RR, 1.06; 95% CI, 0.98 to 1.16) also similar in patients with chronic hypertension (RR, 1.10; 95% CI, 0.98 to 1.24) and patients aged ≥ 65 years (RR, 1.10; 95% CI, 0.99 to 1.21). No significant difference in adverse events was observed between the different groups (RR, 1.04; 95% CI, 0.87 1.24), but supraventricular arrhythmia was significantly higher in the higher MAP group (RR, 1.73; 95% CI, 1.15 to 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 for patients with chronic hypertension. Systematic review registration: UMIN Clinical Trials Registry, UMIN000042624
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Yoshimoto et al. (2022) conducted a meta-analysis in Vasodilatory shock (n=3,357). Higher mean arterial pressure (MAP) target vs. Lower mean arterial pressure (MAP) target (60-70 mmHg) was evaluated on All-cause mortality (RR 1.06, 95% CI 0.98-1.16). A higher mean arterial pressure target (>70 mmHg) did not 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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