Key result
Targeted MAP management increases time in target range but fails to reduce postoperative organ dysfunction.
Why the study?
Targeting blood pressures closer to a patient's normal could reduce post-operative morbidity in high-risk patients undergoing abdominal surgery, motivating this evaluation of targeted mean arterial pressure versus standard care on organ dysfunction.
Does targeted mean arterial pressure management (within 20% of baseline) reduce 24-hour post-operative organ dysfunction compared to standard care in high-risk patients undergoing major abdominal surgeries?
RCT (n=130)
Randomised to Group T (n=60) or Group S (n=70)
Does targeted mean arterial pressure management (within 20% of baseline) reduce 24-hour post-operative organ dysfunction compared to standard care in high-risk patients undergoing major abdominal surgeries?
In high-risk patients undergoing major abdominal surgery, targeting MAP within 20% of baseline improved hemodynamic target attainment compared to standard care but did not reduce 24-hour post-operative organ dysfunction or mortality.
Answers are grounded in this paper and cite their sources.
Targeted MAP management does not reduce organ dysfunction despite better control; challenges routine adoption and leaves open larger outcome trials.
Background and Aims: Targeting blood pressures closer to the patient’s normal could result in a reduction in post-operative morbidity amongst high-risk patients undergoing abdominal surgery. The study primarily evaluated the impact of targeted mean arterial pressure (MAP) (20% baseline) versus standard care on organ dysfunction. The secondary outcomes assessed were length of intensive care unit (ICU) and hospital stay along with all-cause mortality. Methods: Patients aged 45 years and above with diabetes mellitus, coronary artery, peripheral or cerebral vascular disease ( n = 130) undergoing major abdominal surgeries were randomised to either Group T (targeted MAP, n = 60) or Group S (standard care n = 70) and primary outcomes measured at 24 h. Lengths of ICU stay and hospital stay and all-cause mortality were noted. Results: Post-operative troponins, creatinine, platelet count, international normalised ratio, and cognitive and respiratory outcomes were comparable. The time-weighted average of MAP <65 mm Hg was 0.017 ± 0.127 mm Hg in Group T and 0.057 ± 0.295 mm Hg in Group S, P = 0.135, while the time spent within the target MAP range was higher in Group T, 91.3% versus 77.8%, P < 0.001. The ICU stay was 3.0 (2–4) vs. 4 (3.2–5) days, P < 0.001, and hospital stay 5 (4–6) vs. 6.0 (5–7) days ( P < 0.001) in Group S vs. Group T, while the mortality was comparable. Conclusion: Targeted blood pressure management in high-risk patients undergoing abdominal surgery did not result in differences in post-operative outcomes in comparison to the standard care. The lengths of ICU and hospital stay were longer in Group T, probably due to the higher risk profile of patients in this group.
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Venkatesan et al. (2026) conducted an RCT in High-risk patients undergoing major abdominal surgeries (n=130). Targeted mean arterial pressure (MAP) management (within 20% of baseline) vs. Standard care was evaluated on Post-operative organ dysfunction (troponins, creatinine, platelet count, international normalised ratio, and cognitive and respiratory outcomes) at 24 hours. Targeted mean arterial pressure management increased time in target range (91.3% vs 77.8%, P<0.001) compared to standard care without changing 24-hour post-operative organ dysfunction outcomes.
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