More MAP Isn't Always Better

The ongoing vasopressor conundrum.

The problem of choosing appropriate blood pressure targets in sepsis remains confounding. The good ol’ 65 Trial suggested a bit of permissive hypotension wouldn’t be harmful. But, hypotension is all relative – and elderly folks with chronic hypertension may not always tolerate lower MAPs.

So, how about: high-target (80-85 mmHg) vs. low-target (65-75 mmHg) in an open-label trial in Japan? Well, that’s OPTPRESS, an open-label trial stopped early for harm:

There’s a lot of consider here – the obvious one being “unneeded vasopressors = bad”. However, one of the interesting features of this trial was the early use of vasopressin, particularly in the high-target group. There has been a little bit of work showing improved survival patients in whom vasopressin was initiated early, and this may add to further equipoise requiring prospective verification before uptake.

There’s also the classic “we didn’t really hit our targets” feature:

Which many of you may be familiar with from other blood pressure trials, as well as investigations of targeted temperature management. The main reason for this, here, was related to patient improvement, where half of control group patients were weaned from vasopressors within just a couple days.

Regardless, interesting data – and look forward to seeing more testing along these lines!