A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-07

AUTHORS

Mathieu Hylands, Morten Hylander Moller, Pierre Asfar, Augustin Toma, Anne Julie Frenette, Nicolas Beaudoin, Émilie Belley-Côté, Frédérick D’Aragon, Jon Henrik Laake, Reed Alexander Siemieniuk, Emmanuel Charbonney, François Lauzier, Joey Kwong, Bram Rochwerg, Per Olav Vandvik, Gordon Guyatt, François Lamontagne

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. More... »

PAGES

703-715

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12630-017-0877-1

DOI

http://dx.doi.org/10.1007/s12630-017-0877-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1085396029

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28497426


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