Blood Pressure Targets for Adults with Vasodilatory Shock: An Individual Patient Data Meta-Analysis

Federico Angriman, Neda Momenzade, Neill K.J. Adhikari, Paul R Mouncey, Pierre Asfar, Christopher J. Yarnell, Sean Wei Xiang Ong, Ruxandra Pinto, James C. Doidge, Manu Shankar-Hari, Michael O Harhay, Marie-Helene Masse, David Harrison, Kathryn M. Rowan, Francis Carter, Felix Camirand-Lemyre, Francois Lamontagne*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: We sought to estimate whether a lower mean arterial blood pressure target,
compared with a higher mean arterial blood pressure target, reduced 90-day all-cause
mortality among adult critically ill patients with vasodilatory shock.
Methods: Individual patient data meta-analysis of randomized controlled trials identified in
a systematic literature search. The main exposure was a lower mean arterial pressure target
compared to a higher mean arterial pressure target (including usual care). The primary
outcome was all-cause 90-day mortality. We used a Bayesian random ekects log-binomial
model to estimate risk ratios (RR) with 95% credible intervals (Crl).
Results: 3352 patients were randomized in three trials (65-Trial, SEPSISPAM trial, and the
OVATION pilot trial) between 2010 and 2019 across 103 hospitals from the United Kingdom,
France, and Canada. When compared to a higher mean arterial blood pressure target or
usual care, the risk ratio for all-cause 90-day mortality associated with a lower blood
pressure target was 0.93 (95% CrI 0.76 – 1.07; low certainty, posterior probability of benefit
87%). Results were consistent across multiple secondary and sensitivity analyses, including
adjustment for prognostically important baseline covariates and alternative modelling
techniques. Multiple approaches to evaluate heterogeneity of treatment ekect did not
identify any subgroups that may potentially benefit from higher mean arterial blood pressure
targets.
Conclusion: Targeting a lower mean arterial blood pressure for vasopressor therapy in
critically ill patients with vasodilatory shock possibly reduces all-cause 90-day mortality;
however, uncertainty remains.
Keywords: shock; intensive care unit; vasoconstrictor agents; mean arterial pressure; allcause
mortality; Bayesian.
Original languageEnglish
JournalNEJM evidence
Early online date18 Nov 2024
DOIs
Publication statusE-pub ahead of print - 18 Nov 2024

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