A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:64 |
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| Enthalten in: |
Canadian journal of anaesthesia = Journal canadien d'anesthesie - 64(2017), 7 vom: 11. Juli, Seite 703-715 |
| Sprache: |
Englisch |
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| Weiterer Titel: |
Une revue systématique des cibles de tension artérielle sous vasopresseurs chez des adultes gravement malades atteints d’hypotension |
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| Beteiligte Personen: |
Hylands, Mathieu [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 09.03.2018 Date Revised 02.12.2018 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s12630-017-0877-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM271824018 |
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| 100 | 1 | |a Hylands, Mathieu |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension |
| 246 | 3 | 3 | |a Une revue systématique des cibles de tension artérielle sous vasopresseurs chez des adultes gravement malades atteints d’hypotension |
| 264 | 1 | |c 2017 | |
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| 500 | |a Date Completed 09.03.2018 | ||
| 500 | |a Date Revised 02.12.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a CONCLUSION: Current evidence does not support a MAP target > 70 mmHg in hypotensive critically ill adult patients requiring vasopressor therapy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Systematic Review | |
| 650 | 7 | |a Vasoconstrictor Agents |2 NLM | |
| 700 | 1 | |a Moller, Morten Hylander |e verfasserin |4 aut | |
| 700 | 1 | |a Asfar, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Toma, Augustin |e verfasserin |4 aut | |
| 700 | 1 | |a Frenette, Anne Julie |e verfasserin |4 aut | |
| 700 | 1 | |a Beaudoin, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Belley-Côté, Émilie |e verfasserin |4 aut | |
| 700 | 1 | |a D'Aragon, Frédérick |e verfasserin |4 aut | |
| 700 | 1 | |a Laake, Jon Henrik |e verfasserin |4 aut | |
| 700 | 1 | |a Siemieniuk, Reed Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Charbonney, Emmanuel |e verfasserin |4 aut | |
| 700 | 1 | |a Lauzier, François |e verfasserin |4 aut | |
| 700 | 1 | |a Kwong, Joey |e verfasserin |4 aut | |
| 700 | 1 | |a Rochwerg, Bram |e verfasserin |4 aut | |
| 700 | 1 | |a Vandvik, Per Olav |e verfasserin |4 aut | |
| 700 | 1 | |a Guyatt, Gordon |e verfasserin |4 aut | |
| 700 | 1 | |a Lamontagne, François |e verfasserin |4 aut | |
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