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Blood Pressure Targets for Adults with Vasodilatory Shock - An Individual Patient Data Meta-Analysis
Federico Angriman1,2,3, Neda Momenzade4, Neill K J Adhikari1,2
1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto.
NEJM Evidence
|November 18, 2024
Summary
A lower mean arterial blood pressure target may reduce 90-day mortality in critically ill patients with vasodilatory shock. However, evidence certainty is low, and potential harm cannot be excluded.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
- Clinical Trials & Meta-Analysis
Background:
- Vasodilatory shock is a critical condition requiring vasopressor support.
- Optimizing mean arterial blood pressure (MAP) targets is crucial for patient outcomes.
- Uncertainty exists regarding the optimal MAP target in critically ill patients.
Purpose of the Study:
- To compare the effect of a lower MAP target versus a higher MAP target on 90-day all-cause mortality.
- To analyze data from randomized controlled trials (RCTs) on MAP targets in vasodilatory shock.
- To determine if a lower MAP target reduces mortality in critically ill adults.
Main Methods:
- Individual patient data meta-analysis of three RCTs (SEPSISPAM, OVATION, 65-Trial).
- Inclusion of 3352 critically ill adult patients with vasodilatory shock.
- Bayesian random effects log-binomial model used to estimate risk ratios for 90-day mortality.
Main Results:
- A lower MAP target showed a risk ratio of 0.93 (95% CrI, 0.76–1.07) for 90-day mortality compared to higher targets.
- Posterior probability of benefit for lower MAP targets was 87%, with low certainty of evidence.
- No subgroups identified that specifically benefit from higher MAP targets.
Conclusions:
- Targeting a lower MAP may possibly reduce 90-day mortality in vasodilatory shock.
- The certainty of evidence supporting lower MAP targets is low.
- The analysis does not rule out potential overall harm from lower MAP targets.
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