A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock
Abstract Background Minimizing relative hypotension, or mean arterial pressure (MAP) deficit, by targeting patients’ own pre-illness MAP (individualized MAP) during vasopressor therapy is a potential strategy to improve outcomes among ICU patients with shock. We conducted a prospective, open label,...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
|
| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-025-00798-8 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849704141883965440 |
|---|---|
| author | Rakshit Panwar Bairbre McNicholas Ciprian Nita Alison Gibberd Amber-Louise Poulter Marcia Tauares Lauren Ferguson |
| author_facet | Rakshit Panwar Bairbre McNicholas Ciprian Nita Alison Gibberd Amber-Louise Poulter Marcia Tauares Lauren Ferguson |
| author_sort | Rakshit Panwar |
| collection | DOAJ |
| description | Abstract Background Minimizing relative hypotension, or mean arterial pressure (MAP) deficit, by targeting patients’ own pre-illness MAP (individualized MAP) during vasopressor therapy is a potential strategy to improve outcomes among ICU patients with shock. We conducted a prospective, open label, parallel-group, pilot RCT to assess feasibility and safety of this intervention compared to standard care. Methods Thirty-seven eligible patients, aged 40 years or older and receiving vasopressor support for shock, were randomly allocated to individualized MAP target (N = 17) or standard MAP target (N = 20) at two multidisciplinary ICUs in Australia and Ireland. Pre-specified endpoints were time-weighted average MAP-deficit (i.e., percentage difference between patients’ pre-illness MAP and achieved-MAP), percentage time spent with > 20% MAP-deficit, major adverse kidney events (MAKE-14), 14-day and 90-day all-cause mortality, and cardiovascular adverse events within 28 days of randomization. All comparisons of efficacy outcomes were exploratory. Results The median MAP-deficit and percentage time with > 20% MAP-deficit with individualized MAP vs. standard MAP were 7% [interquartile range: 2–16] vs. 18% [9–23] (p = 0.048), and 8% [0–43] vs. 53% [14–75] (p = 0.03), respectively. MAKE-14 (2/17 (12%) vs. 4/20 (20%), p = 0.67), 14-day mortality (1/17 (6%) vs. 3/20 (15%), p = 0.61), 90-day mortality (2/17 (12%) vs. 4/20 (20%), p = 0.67) and cardiovascular adverse events were similar for both groups. Conclusions This pilot RCT demonstrated that an individualized MAP target strategy was feasible to implement. No adverse safety signals were evident. These data and study procedures helped inform the design of a definitive RCT on the question of individualized MAP targets among critically ill patients with shock. Study registration: ACTRN12618000571279. |
| format | Article |
| id | doaj-art-d7283b91db674dc2a83fbe1cac23b890 |
| institution | DOAJ |
| issn | 2052-0492 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj-art-d7283b91db674dc2a83fbe1cac23b8902025-08-20T03:16:52ZengBMCJournal of Intensive Care2052-04922025-05-0113111110.1186/s40560-025-00798-8A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shockRakshit Panwar0Bairbre McNicholas1Ciprian Nita2Alison Gibberd3Amber-Louise Poulter4Marcia Tauares5Lauren Ferguson6Intensive Care Unit, John Hunter HospitalIntensive Care Unit, Galway University HospitalIntensive Care Unit, Galway University HospitalHunter Medical Research InstituteIntensive Care Unit, John Hunter HospitalIntensive Care Unit, Galway University HospitalIntensive Care Unit, Galway University HospitalAbstract Background Minimizing relative hypotension, or mean arterial pressure (MAP) deficit, by targeting patients’ own pre-illness MAP (individualized MAP) during vasopressor therapy is a potential strategy to improve outcomes among ICU patients with shock. We conducted a prospective, open label, parallel-group, pilot RCT to assess feasibility and safety of this intervention compared to standard care. Methods Thirty-seven eligible patients, aged 40 years or older and receiving vasopressor support for shock, were randomly allocated to individualized MAP target (N = 17) or standard MAP target (N = 20) at two multidisciplinary ICUs in Australia and Ireland. Pre-specified endpoints were time-weighted average MAP-deficit (i.e., percentage difference between patients’ pre-illness MAP and achieved-MAP), percentage time spent with > 20% MAP-deficit, major adverse kidney events (MAKE-14), 14-day and 90-day all-cause mortality, and cardiovascular adverse events within 28 days of randomization. All comparisons of efficacy outcomes were exploratory. Results The median MAP-deficit and percentage time with > 20% MAP-deficit with individualized MAP vs. standard MAP were 7% [interquartile range: 2–16] vs. 18% [9–23] (p = 0.048), and 8% [0–43] vs. 53% [14–75] (p = 0.03), respectively. MAKE-14 (2/17 (12%) vs. 4/20 (20%), p = 0.67), 14-day mortality (1/17 (6%) vs. 3/20 (15%), p = 0.61), 90-day mortality (2/17 (12%) vs. 4/20 (20%), p = 0.67) and cardiovascular adverse events were similar for both groups. Conclusions This pilot RCT demonstrated that an individualized MAP target strategy was feasible to implement. No adverse safety signals were evident. These data and study procedures helped inform the design of a definitive RCT on the question of individualized MAP targets among critically ill patients with shock. Study registration: ACTRN12618000571279.https://doi.org/10.1186/s40560-025-00798-8Blood pressure targetMean arterial pressure deficitRelative hypotensionIntensive careShock |
| spellingShingle | Rakshit Panwar Bairbre McNicholas Ciprian Nita Alison Gibberd Amber-Louise Poulter Marcia Tauares Lauren Ferguson A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock Journal of Intensive Care Blood pressure target Mean arterial pressure deficit Relative hypotension Intensive care Shock |
| title | A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock |
| title_full | A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock |
| title_fullStr | A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock |
| title_full_unstemmed | A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock |
| title_short | A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock |
| title_sort | pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock |
| topic | Blood pressure target Mean arterial pressure deficit Relative hypotension Intensive care Shock |
| url | https://doi.org/10.1186/s40560-025-00798-8 |
| work_keys_str_mv | AT rakshitpanwar apilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT bairbremcnicholas apilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT cipriannita apilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT alisongibberd apilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT amberlouisepoulter apilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT marciatauares apilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT laurenferguson apilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT rakshitpanwar pilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT bairbremcnicholas pilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT cipriannita pilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT alisongibberd pilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT amberlouisepoulter pilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT marciatauares pilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock AT laurenferguson pilotmulticenterrandomizedcontrolledtrialonindividualizedbloodpressuretargetsversusstandardcareamongcriticallyillpatientswithshock |