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Can J Anaesth. 2017 Jul;64(7):703-715. doi: 10.1007/s12630-017-0877-1. Epub 2017 May 11.

A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension.

Author information

1
Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada.
2
Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
3
Centre Hospitalier Universitaire d'Angers, Angers, France.
4
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
5
Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, QC, Canada.
6
Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
7
Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada.
8
Centre de recherche du CHU de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada.
9
Oslo Universitetssykehus Ulleval, Oslo, Norway.
10
Centre de Recherche du CHU de Québec - Université Laval, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Quebec, QC, Canada.
11
Wuhan University, Center for Evidence-Based and Translational Medicine Zhongnan Hospital, Wuhan, China.
12
Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
13
Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
14
Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada. francois.lamontagne@usherbrooke.ca.
15
Centre de recherche du CHU de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada. francois.lamontagne@usherbrooke.ca.

Abstract

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.

PMID:
28497426
DOI:
10.1007/s12630-017-0877-1
[Indexed for MEDLINE]

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