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

Mathieu Hylands; Morten Hylander Moller; Pierre Asfar; Augustin Toma; Anne Julie Frenette; Nicolas Beaudoin; Émilie Belley-Côté; Frédérick D’Aragon; Jon Henrik Laake; Reed Alexander Siemieniuk; Emmanuel Charbonney; François Lauzier; Joey Kwong; Bram Rochwerg; Per Olav Vandvik; Gordon Guyatt; François Lamontagne

doi:10.1007/s12630-017-0877-1

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

Mathieu Hylands, Morten Hylander Moller, Pierre Asfar, Augustin Toma, Anne Julie Frenette, Nicolas Beaudoin, Émilie Belley-Côté, Frédérick D’Aragon, Jon Henrik Laake, Reed Alexander Siemieniuk, Emmanuel Charbonney, François Lauzier, Joey Kwong, Bram Rochwerg, Per Olav Vandvik, Gordon Guyatt, François Lamontagne^*

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin

13 Citationer (Scopus)

Abstract

Purpose: 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. Methods: 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. Results: 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% confidence interval [CI], 0.90 to 1.23; P = 0.54), and neither age (P = 0.17) nor chronic hypertension (P = 0.32) modified the overall effect. Nevertheless, higher blood pressure targets were associated with a greater risk of new-onset supraventricular cardiac arrhythmia (RR, 2.08; 95% CI, 1.28 to 3.38; P < 0.01). Conclusion: Current evidence does not support a MAP target > 70 mmHg in hypotensive critically ill adult patients requiring vasopressor therapy.

Originalsprog	Engelsk
Tidsskrift	Canadian Journal of Anesthesia
Vol/bind	64
Udgave nummer	7
Sider (fra-til)	703-715
Antal sider	13
ISSN	0832-610X
DOI	https://doi.org/10.1007/s12630-017-0877-1
Status	Udgivet - jul. 2017

Adgang til dokumentet

10.1007/s12630-017-0877-1

s12630-017-0877-1.pdfForlagets udgivne version, 1,44 MB

Citationsformater

Hylands, M., Moller, M. H., Asfar, P., Toma, A., Frenette, A. J., Beaudoin, N., Belley-Côté, É., D’Aragon, F., Laake, J. H., Siemieniuk, R. A., Charbonney, E., Lauzier, F., Kwong, J., Rochwerg, B., Vandvik, P. O., Guyatt, G., & Lamontagne, F. (2017). A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension. Canadian Journal of Anesthesia, 64(7), 703-715. https://doi.org/10.1007/s12630-017-0877-1

Hylands, M, Moller, MH, Asfar, P, Toma, A, Frenette, AJ, Beaudoin, N, Belley-Côté, É, D’Aragon, F, Laake, JH, Siemieniuk, RA, Charbonney, E, Lauzier, F, Kwong, J, Rochwerg, B, Vandvik, PO, Guyatt, G & Lamontagne, F 2017, 'A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension', Canadian Journal of Anesthesia, bind 64, nr. 7, s. 703-715. https://doi.org/10.1007/s12630-017-0877-1

@article{60b5cf2c20044ec8be01c70221a70aea,

title = "A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension",

abstract = "Purpose: 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. Methods: We searched MEDLINE{\textregistered}, EMBASE{\texttrademark}, 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. Results: 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% confidence interval [CI], 0.90 to 1.23; P = 0.54), and neither age (P = 0.17) nor chronic hypertension (P = 0.32) modified the overall effect. Nevertheless, higher blood pressure targets were associated with a greater risk of new-onset supraventricular cardiac arrhythmia (RR, 2.08; 95% CI, 1.28 to 3.38; P < 0.01). Conclusion: Current evidence does not support a MAP target > 70 mmHg in hypotensive critically ill adult patients requiring vasopressor therapy.",

author = "Mathieu Hylands and Moller, {Morten Hylander} and Pierre Asfar and Augustin Toma and Frenette, {Anne Julie} and Nicolas Beaudoin and {\'E}milie Belley-C{\^o}t{\'e} and Fr{\'e}d{\'e}rick D{\textquoteright}Aragon and Laake, {Jon Henrik} and Siemieniuk, {Reed Alexander} and Emmanuel Charbonney and Fran{\c c}ois Lauzier and Joey Kwong and Bram Rochwerg and Vandvik, {Per Olav} and Gordon Guyatt and Fran{\c c}ois Lamontagne",

year = "2017",

month = jul,

doi = "10.1007/s12630-017-0877-1",

language = "English",

volume = "64",

pages = "703--715",

journal = "Canadian Journal of Anesthesia",

issn = "0832-610X",

publisher = "Springer",

number = "7",

}

TY - JOUR

T1 - A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension

AU - Hylands, Mathieu

AU - Moller, Morten Hylander

AU - Asfar, Pierre

AU - Toma, Augustin

AU - Frenette, Anne Julie

AU - Beaudoin, Nicolas

AU - Belley-Côté, Émilie

AU - D’Aragon, Frédérick

AU - Laake, Jon Henrik

AU - Siemieniuk, Reed Alexander

AU - Charbonney, Emmanuel

AU - Lauzier, François

AU - Kwong, Joey

AU - Rochwerg, Bram

AU - Vandvik, Per Olav

AU - Guyatt, Gordon

AU - Lamontagne, François

PY - 2017/7

Y1 - 2017/7

N2 - Purpose: 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. Methods: 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. Results: 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% confidence interval [CI], 0.90 to 1.23; P = 0.54), and neither age (P = 0.17) nor chronic hypertension (P = 0.32) modified the overall effect. Nevertheless, higher blood pressure targets were associated with a greater risk of new-onset supraventricular cardiac arrhythmia (RR, 2.08; 95% CI, 1.28 to 3.38; P < 0.01). Conclusion: Current evidence does not support a MAP target > 70 mmHg in hypotensive critically ill adult patients requiring vasopressor therapy.

AB - Purpose: 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. Methods: 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. Results: 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% confidence interval [CI], 0.90 to 1.23; P = 0.54), and neither age (P = 0.17) nor chronic hypertension (P = 0.32) modified the overall effect. Nevertheless, higher blood pressure targets were associated with a greater risk of new-onset supraventricular cardiac arrhythmia (RR, 2.08; 95% CI, 1.28 to 3.38; P < 0.01). Conclusion: Current evidence does not support a MAP target > 70 mmHg in hypotensive critically ill adult patients requiring vasopressor therapy.

U2 - 10.1007/s12630-017-0877-1

DO - 10.1007/s12630-017-0877-1

M3 - Review

C2 - 28497426

AN - SCOPUS:85018713131

SN - 0832-610X

VL - 64

SP - 703

EP - 715

JO - Canadian Journal of Anesthesia

JF - Canadian Journal of Anesthesia

IS - 7

ER -

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

Abstract

Adgang til dokumentet

Fingeraftryk

Citationsformater