Optimal target blood pressure in elderly with septic shock (OPTPRESS) trial: study protocol for a randomized...

Area of Science:

• Critical Care Medicine
• Cardiovascular Physiology
• Geriatric Medicine

Background:

• Hemodynamic stabilization is crucial in septic shock resuscitation, but optimal mean arterial pressure (MAP) targets remain debated.
• Previous trials found no universal benefit for MAP > 65 mmHg in all septic shock patients.
• Higher MAP targets may benefit elderly patients, particularly those with arteriosclerosis.

Purpose of the Study:

• To compare the efficacy of a high MAP target (80-85 mmHg) versus a control MAP target (65-70 mmHg) in adult septic shock patients aged 65 years and older.
• To evaluate the impact of different MAP targets on 90-day all-cause mortality in elderly septic shock patients.
• To inform individualized hemodynamic management strategies for critically ill patients.

Main Methods:

• A multicenter, pragmatic, single-blind randomized controlled trial involving 28 hospitals in Japan.
• Adult patients (≥65 years) with septic shock were randomized to high-target (80-85 mmHg) or control (65-70 mmHg) MAP groups.
• MAP targets were maintained for 72 hours or until vasopressors were no longer needed; vasopressin was used if norepinephrine dose exceeded 0.1 μg/kg/min.

Main Results:

• Primary outcome is 90-day all-cause mortality.
• Secondary outcomes will assess the impact of MAP targets on organ support and adverse events.
• Data analysis will focus on comparing mortality rates between the high-target and control groups.

Conclusions:

• Findings will offer insights into septic shock resuscitation strategies for an aging global population.
• The study aims to enhance understanding of individualized treatment in hemodynamic management for critically ill patients.
• Results will guide clinical practice regarding optimal MAP targets in elderly septic shock survivors.