Standard care versus individualized blood pressure targets among critically ill patients with shock: A multicenter feasibility and preliminary efficacy study

Panwar, Rakshit; Van Haren, Frank; Cazzola, Federica; Nourse, Mary; Brinkerhoff, Gail; Quail, Anthony

Title: Standard care versus individualized blood pressure targets among critically ill patients with shock: A multicenter feasibility and preliminary efficacy study
Creator: Panwar, Rakshit; Van Haren, Frank; Cazzola, Federica; Nourse, Mary; Brinkerhoff, Gail; Quail, Anthony
Relation: Journal of Critical Care Vol. 70, no. 154052
Publisher Link: http://dx.doi.org/10.1016/j.jcrc.2022.154052
Publisher: Elsevier
Resource Type: journal article
Date: 2022
Description: Purpose: Emerging evidence suggests that minimizing mean perfusion pressure (MPP) deficit during vasopressor therapy for shock can potentially reduce adverse kidney-related outcomes in ICU. We assessed feasibility and preliminary efficacy of individualizing MPP targets based on patients' own pre-illness basal-MPP among vasopressor-treated patients with shock. Material and methods: In this prospective before-and-after trial, 31 patients during the ‘before’/observational phase and 31 patients during the ‘after’/intervention phase were enrolled at two tertiary-level Australian ICUs. Feasibility endpoint was time-weighted average MPP-deficit during vasopressor therapy. Preliminary efficacy outcomes were new significant AKI, major adverse kidney events within 14 days (MAKE-14), and 90-day mortality. Results: Patients in the after group had lower MPP-deficit (median 18%, [interquartile range [IQR]: 11–23] vs. 4%, [IQR: 2–9], p < 0.001) and lower incidence of new significant AKI (8/31 [26%] vs. 1/31 [3%], p = 0.01) than the before group. The between-group differences in MAKE-14 (9/31 [29%] vs. 4/31 [13%], p = 0.12) and 90-day mortality (6/31 [19%] vs. 2/31 [6%], p = 0.13) were not statistically significant. Conclusions: An individualized blood pressure target strategy during vasopressor therapy in ICU was feasible and appeared to be efficacious in this preliminary study. Testing this strategy in a larger randomized controlled trial is warranted. Study registration: ACTRN12617001459314.
Subject: blood pressure; mean perfusion pressure deficit; relative hypotension; acute kidney injury; intensive care; shock
Identifier: http://hdl.handle.net/1959.13/1464372
Identifier: uon:46976
Identifier: ISSN:0883-9441
Language: eng
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