Key result
Targeting a patient's own pre-illness mean arterial pressure significantly reduced the median time-weighted average MAP-deficit to 7% compared to 18% with standard care in critically ill patients with shock.
Why the study?
Targeting patients' pre-illness MAP during vasopressor therapy is a potential strategy to minimize relative hypotension and improve outcomes in shock, but its feasibility and safety required assessment.
Does an individualized MAP target reduce time-weighted average MAP-deficit compared to a standard MAP target of 65 mmHg in critically ill patients with shock?
RCT (n=37)
Open-label
Permuted block randomization with random block sizes, stratified by site
Yes
Does an individualized MAP target reduce time-weighted average MAP-deficit compared to a standard MAP target of 65 mmHg in critically ill patients with shock?
Absolute Event Rate: 7% vs 18%
p-value: p=0.048
Targeting a patient's pre-illness blood pressure during vasopressor therapy for shock is feasible and significantly reduces relative hypotension without increasing adverse events.
Individualized MAP targets reduce relative hypotension in shock; supports outcome trials before changing practice.
BACKGROUND: Minimizing relative hypotension, or mean arterial pressure (MAP) deficit, by targeting patients' own pre-illness MAP (individualized MAP) during vasopressor therapy is a potential strategy to improve outcomes among ICU patients with shock. We conducted a prospective, open label, parallel-group, pilot RCT to assess feasibility and safety of this intervention compared to standard care. METHODS: Thirty-seven eligible patients, aged 40 years or older and receiving vasopressor support for shock, were randomly allocated to individualized MAP target (N = 17) or standard MAP target (N = 20) at two multidisciplinary ICUs in Australia and Ireland. Pre-specified endpoints were time-weighted average MAP-deficit (i.e., percentage difference between patients' pre-illness MAP and achieved-MAP), percentage time spent with > 20% MAP-deficit, major adverse kidney events (MAKE-14), 14-day and 90-day all-cause mortality, and cardiovascular adverse events within 28 days of randomization. All comparisons of efficacy outcomes were exploratory. RESULTS: The median MAP-deficit and percentage time with > 20% MAP-deficit with individualized MAP vs. standard MAP were 7% [interquartile range: 2-16] vs. 18% [9-23] (p = 0.048), and 8% [0-43] vs. 53% [14-75] (p = 0.03), respectively. MAKE-14 (2/17 (12%) vs. 4/20 (20%), p = 0.67), 14-day mortality (1/17 (6%) vs. 3/20 (15%), p = 0.61), 90-day mortality (2/17 (12%) vs. 4/20 (20%), p = 0.67) and cardiovascular adverse events were similar for both groups. CONCLUSIONS: This pilot RCT demonstrated that an individualized MAP target strategy was feasible to implement. No adverse safety signals were evident. These data and study procedures helped inform the design of a definitive RCT on the question of individualized MAP targets among critically ill patients with shock. STUDY REGISTRATION: ACTRN12618000571279.
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Panwar et al. (2025) conducted an RCT in Shock in critically ill patients (n=37). Individualized MAP target (targeting patient's own pre-illness MAP) vs. Standard MAP target (65 mmHg) was evaluated on Time-weighted average MAP-deficit (p=0.048). Targeting a patient's own pre-illness mean arterial pressure significantly reduced the median time-weighted average MAP-deficit to 7% compared to 18% with standard care in critically ill patients with shock.
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