TY - JOUR
T1 - Higher versus lower blood pressure targets for vasopressor therapy in shock
T2 - A multicentre pilot randomized controlled trial
AU - Canadian Critical Care Trials Group.
AU - Lamontagne, François
AU - Meade, Maureen O.
AU - Hébert, Paul C.
AU - Asfar, Pierre
AU - Lauzier, François
AU - Seely, Andrew J.E.
AU - Day, Andrew G.
AU - Mehta, Sangeeta
AU - Muscedere, John
AU - Bagshaw, Sean M.
AU - Ferguson, Niall D.
AU - Cook, Deborah J.
AU - Kanji, Salmaan
AU - Turgeon, Alexis F.
AU - Herridge, Margaret S.
AU - Subramanian, Sanjay
AU - Lacroix, Jacques
AU - Adhikari, Neill K.J.
AU - Scales, Damon C.
AU - Fox-Robichaud, Alison
AU - Skrobik, Yoanna
AU - Whitlock, Richard P.
AU - Green, Robert S.
AU - Koo, Karen K.Y.
AU - Tanguay, Teddie
AU - Magder, Sheldon
AU - Heyland, Daren K.
N1 - Publisher Copyright:
© 2016 Springer-Verlag Berlin Heidelberg and ESICM.
PY - 2016/4
Y1 - 2016/4
N2 - Purpose: In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods: We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regard-less of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results: A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients.
AB - Purpose: In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods: We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regard-less of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results: A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients.
KW - Blood pressure targets
KW - Resuscitation
KW - Shock
KW - Vasopressors
UR - http://www.scopus.com/inward/record.url?scp=84958770883&partnerID=8YFLogxK
U2 - 10.1007/s00134-016-4237-3
DO - 10.1007/s00134-016-4237-3
M3 - Article
C2 - 26891677
AN - SCOPUS:84958770883
SN - 0342-4642
VL - 42
SP - 542
EP - 550
JO - Intensive care medicine
JF - Intensive care medicine
IS - 4
ER -