Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock

Autor: Deborah J. Cook, Gordon H. Guyatt, Peter Radermacher, Nicolas Beaudoin, Ferhat Meziani, Andrew G. Day, Maureen O. Meade, Francois Lamontagne, Frédérick D’Aragon, Mathieu Hylands, Paul C. Hébert, Pierre Asfar, J. M. Chretien
Přispěvatelé: Universitätsklinikum Ulm - University Hospital of Ulm, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Agroressources et Impacts environnementaux (AgroImpact), Institut National de la Recherche Agronomique (INRA), University of Guelph, Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Rok vydání: 2017
Předmět:
Zdroj: Intensive care medicine
Intensive care medicine, 2018, 44, pp.12-21. ⟨10.1007/s00134-017-5016-5⟩
ISSN: 1432-1238
0342-4642
DOI: 10.1007/s00134-017-5016-5
Popis: International audience; PURPOSE: Guidelines for shock recommend mean arterial pressure (MAP) targets for vasopressor therapy of at least 65mmHg and, until recently, suggested that patients with underlying chronic hypertension and atherosclerosis may benefit from higher targets. We conducted an individual patient-data meta-analysis of recent trials to determine if patient variables modify the effect of different MAP targets.METHODS: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials of higher versus lower blood pressure targets for vasopressor therapy in adult patients in shock (until November 2017). After obtaining individual patient data from both eligible trials, we used a modified version of the Cochrane Collaboration's instrument to assess the risk of bias of included trials. The primary outcome was 28-day mortality.RESULTS: Included trials enrolled 894 patients. Controlling for trial and site, the OR for 28-day mortality for the higher versus lower MAP targets was 1.15 (95% CI 0.87-1.52). Treatment effect varied by duration of vasopressors before randomization (interaction p=0.017), but not by chronic hypertension, congestive heart failure or age. Risk of death increased in higher MAP groups among patients on vasopressors >6h before randomization (OR 3.00, 95% CI 1.33-6.74).CONCLUSIONS: Targeting higher blood pressure targets may increase mortality in patients who have been treated with vasopressors for more than 6h. Lower blood pressure targets were not associated with patient-important adverse events in any subgroup, including chronically hypertensive patients.
Databáze: OpenAIRE
Externí odkaz: