High versus low blood-pressure target in patients with septic shock.
Open accessAbstract
BACKGROUND: The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown. METHODS: In a multicenter, open-label trial, we randomly assigned 776 patients with septic shock to undergo resuscitation with a mean arterial pressure target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). The primary end point was mortality at day 28. RESULTS: At 28 days, there was no significant between-group difference in mortality, with deaths reported in 142 of 388 patients in the high-target group (36.6%) and 132 of 388 patients in the low-target group (34.0%) (hazard ratio in the high-target group, 1.07; 95% confidence interval [CI], 0.84 to 1.38; P=0.57). There was also no significant difference in mortality at 90 days, with 170 deaths (43.8%) and 164 deaths (42.3%), respectively (hazard ratio, 1.04; 95% CI, 0.83 to 1.30; P=0.74). The occurrence of serious adverse events did not differ significantly between the two groups (74 events [19.1%] and 69 events [17.8%], respectively; P=0.64). However, the incidence of newly diagnosed atrial fibrillation was higher in the high-target group than in the low-target group. Among patients with chronic hypertension, those in the high-target group required less renal-replacement therapy than did those in the low-target group, but such therapy was not associated with a difference in mortality. CONCLUSIONS: Targeting a mean arterial pressure of 80 to 85 mm Hg, as compared with 65 to 70 mm Hg, in patients with septic shock undergoing resuscitation did not result in significant differences in mortality at either 28 or 90 days. (Funded by the French Ministry of Health; SEPSISPAM ClinicalTrials.gov number, NCT01149278.).
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A RCT in septic shock comparing patients who were given vasopressors to target a MAP of 65-70 mm Hg versus a target of 80-85 mm Hg found no difference in mortality.
“This study found no difference in mortality, although a subgroup analysis demonstrated a 10.5% absolute reduction in renal replacement therapy (RRT) with higher MAP targets among patients with chronic hypertension.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [80]
A subgroup analysis demonstrated a 10.5% absolute reduction in renal replacement therapy (RRT) with higher MAP targets among patients with chronic hypertension.
“although a subgroup analysis demonstrated a 10.5% absolute reduction in renal replacement therapy (RRT) with higher MAP targets among patients with chronic hypertension.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [80]
Targeting higher MAP with vasopressors was associated with a higher risk of atrial fibrillation.
“Additionally, targeting higher MAP with vasopressors was associated with a higher risk of atrial fibrillation.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [80]
A limitation of this study was that the average MAP in both arms exceeded the targeted range.
“A limitation of this study was that the average MAP in both arms exceeded the targeted range.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [80]
A RCT in septic shock comparing vasopressors to target MAP 65-70 mm Hg versus 80-85 mm Hg found no difference in mortality.
“The recommendation was based principally on a RCT in septic shock comparing patients who were given vasopressors to target a MAP of 65–70 mm Hg, versus a target of 80–85 mm Hg [80]. This study found no difference in mortality”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [80]
A subgroup analysis of that RCT demonstrated a 10.5% absolute reduction in renal replacement therapy with higher MAP targets among patients with chronic hypertension.
“although a sub-group analysis demonstrated a 10.5% absolute reduction in renal replacement therapy (RRT) with higher MAP targets among patients with chronic hypertension.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [80]
Targeting higher MAP with vasopressors was associated with a higher risk of atrial fibrillation.
“In addition, targeting higher MAP with vasopressors was associated with a higher risk of atrial fibrillation.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [80]
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Cites
Bone, R. C., BALK, R. A., Cerra, F. B., Dellinger, R. P., Fein, A. M., Knaus, W. A., Schein, R. M. H., & Sibbald, W. J. (1992) · CHEST Journal · doi:10.1378/chest.101.6.1644 · Cited by 13,192 · see citing works
Early goal-directed therapy in the treatment of severe sepsis and septic shock
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E., & Tomlanovich, M. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010307 · Cited by 10,743 · see citing works
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J. E., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31827e83af · Cited by 9,694 · see citing works
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Intensive Care Medicine · doi:10.1007/s00134-012-2769-8 · Cited by 7,282 · see citing works
Hydrocortisone Therapy for Patients with Septic Shock
Sprung, C. L., Annane, D., Keh, D., Moreno, R. P., Singer, M., Freivogel, K., Weiss, Y., Benbenishty, J. S., Kalenka, A., Forst, H., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa071366 · Cited by 2,162 · see citing works
Comparison of Dopamine and Norepinephrine in the Treatment of Shock
De Backer, D., Biston, P., Devriendt, J., Madl, C., Chochrad, D., Aldecoa, C., Brasseur, A., Defrance, P., Gottignies, P., & Vincent, J.-L. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa0907118 · Cited by 1,940 · see citing works
Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock
Russell, J. A., Walley, K. R., Singer, J., Gordon, A. C., Hébert, P. C., Cooper, D. J., Holmes, C. L., Mehta, S., Granton, J. T., Storms, M. M., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa067373 · Cited by 1,924 · see citing works
Hydroxyethyl Starch 130/0.42 versus Ringer's Acetate in Severe Sepsis
Perner, A., Haase, N., Guttormsen, A. B., Tenhunen, J. J., Klemenzson, G., Åneman, A., Madsen, K. R., Møller, M. H., Elkjær, J. M., Poulsen, L. M., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1204242 · Cited by 1,791 · see citing works
Drotrecogin Alfa (Activated) in Adults with Septic Shock
Ranieri, V. M., Thompson, B., Barie, P. S., Dhainaut, J.-F., Douglas, I. S., Finfer, S. R., Gårdlund, B., Marshall, J. C., Rhodes, A., Artigas, A., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1202290 · Cited by 1,306 · see citing works
López, A., Lorente, J. A., Steingrub, J. S., Bakker, J., McLuckie, A., Willatts, S. M., Brockway, M., Anzueto, A., Holzapfel, L., Breen, D. P., et al. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000105581.01815.c6 · Cited by 917 · see citing works
Autoregulation of Brain Circulation in Severe Arterial Hypertension
Strandgaard, S., Olesen, J., Skinhöj, E., & Lassen, N. A. (1973) · BMJ · doi:10.1136/bmj.1.5852.507 · Cited by 863 · see citing works
Effects of perfusion pressure on tissue perfusion in septic shock.
LeDoux, D., Astiz, M. E., Carpati, C. M., & Rackow, E. C. (2000) · Critical Care Medicine · doi:10.1097/00003246-200008000-00007 · Cited by 586 · see citing works
Annane, D., Vignon, P., Renault, A., Bollaert, P., Charpentier, C., Martin, C., Troché, G., Ricard, J.-D., Nitenberg, G., Papazian, L., et al. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61344-0 · Cited by 557 · see citing works
Self-citationWalkey, A. J., Wiener, R. S., Ghobrial, J. M., Curtis, L. H., & Benjamin, E. J. (2011) · JAMA · doi:10.1001/jama.2011.1615 · Cited by 493 · see citing works
Bourgoin, A., Léone, M., Delmas, A., et al. (2005) · Critical Care Medicine · doi:10.1097/01.ccm.0000157788.20591.23 · Cited by 335 · see citing works
Arterial blood pressure during early sepsis and outcome
Dünser, M. W., Takala, J. A., Ulmer, H., Mayr, V. D., Luckner, G., Jochberger, S., Daudel, F., Lepper, P. M., Hasibeder, W. R., & Jakob, S. M. (2009) · Intensive Care Medicine · doi:10.1007/s00134-009-1427-2 · Cited by 229 · see citing works
Poukkanen, M., Wilkman, E., Vaara, S. T., Pettilä, V., Kaukonen, K., Korhonen, A., Uusaro, A. V., Hovilehto, S., Inkinen, O., Laru‐Sompa, R., et al. (2013) · Critical Care · doi:10.1186/cc13161 · Cited by 194 · see citing works
Badin, J., Boulain, T., Ehrmann, S., Skarzynski, M., Bretagnol, A., Buret, J., Benzékri-Lefèvre, D., Mercier, E., Runge, I., Garot, D., et al. (2011) · Critical Care · doi:10.1186/cc10253 · Cited by 150 · see citing works
Self-citationPottecher, T., Calvat, S., Dupont, H. T., et al. (2006) · Critical Care · doi:10.1186/cc4965 · Cited by 63 · see citing works
Persistent organ dysfunction plus death: a novel, composite outcome measure for critical care trials
Heyland, D. K., Muscedere, J., Drover, J., Jiang, X., Day, A. G., & the Canadian Critical Care Trials Group (2011) · Critical Care · doi:10.1186/cc10110 · Cited by 56 · see citing works
Walkey, A. J., Wiener, R. S., Ghobrial, J. M., et al. (2012) · Survey of Anesthesiology · doi:10.1097/sa.0b013e318269d394 · Cited by 32 · see citing works
Jacobs, F. (2011) · Critical Care · doi:10.1186/cc10417 · Cited by 15 · see citing works
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Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4683-6 · Cited by 6,621 · see citing works
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002255 · Cited by 3,652 · see citing works
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Cecconi, M., Evans, L., Levy, M., & Rhodes, A. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30696-2 · Cited by 2,254 · see citing works
Hernández, G., Ospina-Tascón, G. A., Damiani, L. P., Estenssoro, E., Dubin, A., Hurtado, J., Friedman, G., Castro, R., Alegría, L., Teboul, J.-L., et al. (2019) · JAMA · doi:10.1001/jama.2019.0071 · Cited by 946 · see citing works
Self-citationLower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock
Holst, L. B., Haase, N., Wetterslev, J., Wernerman, J., Guttormsen, A. B., Karlsson, S., Johansson, P. I., Åneman, A., Vang, M. L., Winding, R., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1406617 · Cited by 899 · see citing works
Gordon, A. C., Mason, A. J., Thirunavukkarasu, N., Perkins, G. D., Cecconi, M., Cepkova, M., Pogson, D. G., Aya, H. D., Anjum, A., Frazier, G. J., et al. (2016) · JAMA · doi:10.1001/jama.2016.10485 · Cited by 728 · see citing works
The CLASSIC Trial Group, Hjortrup, P. B., The Scandinavian Critical Care Trials Group, Haase, N., Bundgaard, H., Thomsen, S. L., Winding, R., Pettilä, V., Aaen, A., Lodahl, D., et al. (2016) · Intensive Care Medicine · doi:10.1007/s00134-016-4500-7 · Cited by 376 · see citing works
Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis
Gordon, A. C., Perkins, G. D., Singer, M., McAuley, D. F., Orme, R. M. L., Santhakumaran, S., Mason, A. J., Cross, M., Al-Beidh, F., Best-Lane, J., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1609409 · Cited by 372 · see citing works
Lamontagne, F., Richards-Belle, A., Thomas, K., Harrison, D. A., Sadique, M. Z., Grieve, R. D., Camsooksai, J., Darnell, R., Gordon, A. C., Henry, D., et al. (2020) · JAMA · doi:10.1001/jama.2020.0930 · Cited by 354 · see citing works
for the Canadian Critical Care Trials Group., Lamontagne, F., Meade, M. O., Hébert, P. C., Asfar, P., Lauzier, F., Seely, A. J. E., Day, A. G., Mehta, S., Muscedere, J., et al. (2016) · Intensive Care Medicine · doi:10.1007/s00134-016-4237-3 · Cited by 230 · see citing works
Self-citationEffective hemodynamic monitoring
Pinsky, M. R., Cecconi, M., Chew, M. S., De Backer, D., Douglas, I., Edwards, M., Hamzaoui, O., Hernandez, G., Martin, G., Monnet, X., et al. (2022) · Critical Care · doi:10.1186/s13054-022-04173-z · Cited by 167 · see citing works
Self-citationSurviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
Kattan, E., Hernández, G., Ospina-Tascón, G., Valenzuela, E. D., Bakker, J., & Castro, R. (2020) · Annals of Intensive Care · doi:10.1186/s13613-020-00732-1 · Cited by 100 · see citing works
Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock 2026
Prescott, H. C., Antonelli, M., Alhazzani, W., Møller, M. H., Alshamsi, F., Azevedo, L. C. P., Belley-Cote, E., De Waele, J., Derde, L., Dionne, J. C., et al. (2026) · Critical Care Medicine · doi:10.1097/ccm.0000000000007075 · Cited by 117 · see citing works
The initial resuscitation of septic shock
Cinel, I., Kasapoglu, U. S., Gul, F., & Dellinger, R. P. (2020) · Journal of Critical Care · doi:10.1016/j.jcrc.2020.02.004 · Cited by 69 · see citing works
A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension.
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., et al. (2017) · Canadian Journal of Anesthesia/Journal canadien d'anesthésie · doi:10.1007/s12630-017-0877-1 · Cited by 69 · see citing works
Self-citationFleuren, L. M., Roggeveen, L. F., Guo, T., Waldauf, P., van der Voort, P. H. J., Bosman, R. J., Swart, E. L., Girbes, A. R. J., & Elbers, P. W. G. (2019) · Critical Care · doi:10.1186/s13054-019-2438-1 · Cited by 32 · see citing works
- Authors
- Asfar, P., Meziani, F., Hamel, J.-F., Grelon, F., Megarbane, B., Anguel, N., Mira, J.-P., Dequin, P.-F., Gergaud, S., Weiss, N., Legay, F., Le Tulzo, Y., Conrad, M., Robert, R., Gonzalez, F., Guitton, C., Tamion, F., Tonnelier, J.-M., Guezennec, P., Van Der Linden, T., Vieillard-Baron, A., Mariotte, E., Pradel, G., Lesieur, O., Ricard, J.-D., Hervé, F., du Cheyron, D., Guerin, C., Mercat, A., Teboul, J.-L., & Radermacher, P.
- Affiliations
- Université d'Angers (FR)
- Hôpital Civil, Strasbourg (FR)
- Centre Hospitalier du Mans (FR)
- Bicêtre Hospital (FR)
- Hôpital Cochin (FR)
- Centre Hospitalier Universitaire de Tours (FR)
- Hôpital Européen Georges-Pompidou (FR)
- Centre Hospitalier de Saint-Brieuc (FR)
- Centre Hospitalier Régional et Universitaire de Nancy (FR)
- Centre Hospitalier Universitaire de Poitiers (FR)
- Hôpital Avicenne (FR)
- Centre Hospitalier Universitaire de Nantes (FR)
- Centre Hospitalier Universitaire de Rouen (FR)
- Centre Hospitalier Régional Universitaire de Brest (FR)
- Centre Hospitalier de La Rochelle (FR)
- Université Paris Diderot (FR)
- University Hospital Ulm (DE)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2014-04-24
- Volume
- 370
- Issue
- 17
- Pages
- 1583-1593
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2096350581
- Semantic Scholar
- 421d8e837071ad1b94bc4354b29202161e18ee27
- Cited by
- 1,239
- References
- 22
- Citations by year
- 2026: 86 · 2025: 109 · 2024: 100 · 2023: 89 · 2022: 111 · 2021: 95 · 2020: 109 · 2019: 102 · 2018: 88 · 2017: 104 · 2016: 103 · 2015: 88 · 2014: 51
- FWCI
- 87.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- septic shock, mean arterial pressure targets, fluid resuscitation, 28-day mortality, 90-day mortality, atrial fibrillation, renal replacement therapy, chronic hypertension, Surviving Sepsis Campaign
- MeSH terms
- Aged, Atrial Fibrillation, Blood Pressure, Female, Humans, Male, Middle Aged, Resuscitation, Shock, Septic, Vasoconstrictor Agents, Incidence, Renal Replacement Therapy
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