A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension.
Open accessAbstract
Purpose Clinicians must balance the risks from hypotension with the potential adverse effects of vasopressors. Experts have recommended a mean arterial pressure (MAP) target of at least 65 mmHg, and higher in older patients and in patients with chronic hypertension or atherosclerosis. We conducted a systematic review of randomized-controlled trials comparing higher vs lower blood pressure targets for vasopressor therapy administered to hypotensive critically ill patients.Methods We searched MEDLINE®, EMBASE™, and the Cochrane Central Register of Controlled Trials for studies of higher vs lower blood pressure targets for vasopressor therapy in critically ill hypotensive adult patients. Two reviewers independently assessed trial eligibility based on titles and abstracts, and they then selected full-text reports. Outcomes, subgroups, and analyses were prespecified. We used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to rate the overall confidence in the estimates of intervention effects.Results Of 8001 citations, we retrieved 57 full-text articles and ultimately included two randomized-controlled trials (894 patients). Higher blood pressure targets were not associated with lower mortality (relative risk [RR], 1.05; 95% confidence interval [CI], 0.90 to 1.23; P = 0.54), and neither age (P = 0.17) nor chronic hypertension (P = 0.32) modified the overall effect. Nevertheless, higher blood pressure targets were associated with a greater risk of new-onset supraventricular cardiac arrhythmia (RR, 2.08; 95% CI, 1.28 to 3.38; P < 0.01).Conclusion Current evidence does not support a MAP target > 70 mmHg in hypotensive critically ill adult patients requiring vasopressor therapy.
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A meta-analysis of two RCTs supported that higher MAP targets did not improve survival in septic shock (RR 1.05; 95% CI 0.90-1.23).
“A meta-analysis of two RCTs on this topic supported that higher MAP targets did not improve survival in septic shock (RR 1.05; 95% CI 0.90–1.23) [81].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [81]
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- Authors
- Hylands, M., Moller, M. H., Asfar, P., Toma, A., Frenette, A. J., Beaudoin, N., Belley-Côté, É., D’Aragon, F., Laake, J. H., Siemieniuk, R. A., Charbonney, E., Lauzier, F., Kwong, J., Rochwerg, B., Vandvik, P. O., Guyatt, G., & Lamontagne, F.
- Affiliations
- Université de Sherbrooke (CA)
- Centre Hospitalier Universitaire d'Angers (FR)
- McMaster University (CA)
- Hôpital du Sacré-Cœur de Montréal (CA)
- Oslo University Hospital (NO)
- Centre de recherche du CHU de Québec-Université Laval (CA)
- Wuhan University (CN)
- Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
- Corresponding author
- Lamontagne, François
- ORCID
- Venue
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Published
- 2017-05-11
- Volume
- 64
- Issue
- 7
- Pages
- 703-715
- ISSN
- 0832-610X (ISSN-L)
- 1496-8975
- OpenAlex
- W2612477971
- Semantic Scholar
- dc7b30e0416b786003d341deaca4d5cd20ce687e
- Cited by
- 69
- References
- 30
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 8 · 2023: 7 · 2022: 15 · 2021: 7 · 2020: 7 · 2019: 3 · 2018: 2 · 2017: 3
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Fonds de Recherche du Québec - Santé
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- vasopressor therapy, blood pressure targets, mean arterial pressure, hypotension, critically ill adults, supraventricular arrhythmias, mortality, chronic hypertension, elderly patients, atherosclerosis
- MeSH terms
- Adult, Blood Pressure, Humans, Hypotension, Vasoconstrictor Agents, Randomized Controlled Trials as Topic, Critical Illness, Arterial Pressure
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