A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
Mathieu HylandsFrançois Lamontagne

Abstract

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. 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. 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% con...Continue Reading

References

Sep 1, 1986·Controlled Clinical Trials·R DerSimonian, N Laird
Feb 29, 2008·The New England Journal of Medicine·James A RussellUNKNOWN VASST Investigators
Apr 26, 2008·BMJ : British Medical Journal·Gordon H GuyattUNKNOWN GRADE Working Group
Jul 28, 2009·Journal of Clinical Epidemiology·David MoherUNKNOWN PRISMA Group
Mar 25, 2010·JAMA : the Journal of the American Medical Association·Dirk BasslerTim Ramsay
Oct 12, 2010·Lancet·Neill K J AdhikariGordon D Rubenfeld
Jan 21, 2011·Journal of Clinical Epidemiology·Gordon H GuyattHolger J Schünemann
Aug 2, 2011·Journal of Clinical Epidemiology·Gordon H GuyattUNKNOWN GRADE Working Group
Aug 2, 2011·Journal of Clinical Epidemiology·Gordon H GuyattHolger J Schünemann
Aug 2, 2011·Journal of Clinical Epidemiology·Gordon H GuyattUNKNOWN GRADE Working Group
Aug 16, 2011·Journal of Clinical Epidemiology·Gordon H GuyattHolger J Schünemann
Apr 25, 2012·Intensive Care Medicine·Christian A SchmittingerMartin W Dünser
Jan 29, 2013·Critical Care Medicine·R Phillip DellingerUNKNOWN Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup
Mar 19, 2014·The New England Journal of Medicine·Pierre AsfarUNKNOWN SEPSISPAM Investigators
Oct 2, 2014·The New England Journal of Medicine·Sandra L PeakePatricia Williams
Apr 22, 2015·Shock·Frederick D'AragonUNKNOWN Canadian Critical Care Trials Group
Feb 14, 2016·Intensive Care Medicine·Davide Tommaso Andreis, Mervyn Singer
Feb 20, 2016·Intensive Care Medicine·François LamontagneUNKNOWN Canadian Critical Care Trials Group.
Sep 30, 2016·BMJ : British Medical Journal·Reed A SiemieniukPer O Vandvik
Jan 21, 2017·PloS One·Francois LamontagneDaren K Heyland
May 13, 2017·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Bram RochwergFrançois Lamontagne
May 13, 2017·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Bram RochwergFrançois Lamontagne

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Citations

May 13, 2017·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Reed A C Siemieniuk, Gordon H Guyatt
Feb 13, 2019·Internal Medicine Journal·Kelly ThompsonSimon Finfer
Oct 7, 2017·Current Opinion in Critical Care·Hitesh Gidwani, Hernando Gómez
Jul 23, 2020·Drugs·John G RizkDonald N Forthal
Mar 9, 2021·The American Journal of Emergency Medicine·Romain JouffroyBenoit Vivien
Sep 3, 2021·Critical Care Medicine·Manu Shankar-HariDerek C Angus

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