Mean arterial pressure in critically ill adults receiving vasopressors: A multicentre, observational study

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2025-03-01 DOI:10.1016/j.ccrj.2025.100103

Kyle C. White MBBS MPH , Lachlan Quick MBBS , Zachary Durkin MBBS , James McCullough FCICM, MMed , Kevin B. Laupland MD, PhD , Sebastiaan Blank FCICM , Antony G. Attokaran MBBS, FCICM , Aashish Kumar MBBS, FCICM , Kiran Shekar MBBS, PhD , Peter Garrett MBBS, FCICM , Jason Meyer RN, MSc , Alexis Tabah MD, FCICM , Mahesh Ramanan FCICM, MMed , Stephen Luke MBBS, FCICM , Anis Chaba MD , Rinaldo Bellomo MD, PhD , François Lamontagne MD, MSc , Paul J. Young MBChB, PhD

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引用次数: 0

Abstract

Objective

Mean arterial pressure (MAP) management is a key aspect of treatment in critically ill patients receiving vasopressor therapy. Guidelines in different clinical subgroups have proposed various target MAP values. This study aimed to describe delivered MAP values and corresponding vasopressor doses in such patients.

Design

Multicenter, retrospective cohort study of adult intensive care unit (ICU) admissions.

Setting

12 ICUs in Queensland, Australia, from January 1, 2015, to December 31, 2021.

Participants

Patients receiving vasopressors for at least six continuous hours in the ICU. We studied the delivered MAP values using hourly data based on averaging all validated values obtained from the ICU monitors and average hourly doses of vasopressors.

Main Outcome Measure

The primary outcome was the mean MAP during the entire cohort's first 72 hours of ICU admission, whilst vasopressors were administered.

Results

In 26,519 patients who received vasopressors for at least six continuous hours, the median age was 62 years, and 9,373 (35%) were admitted after elective surgery. The median time from ICU admission to vasopressor commencement was 2 hours, and the median duration of vasopressor therapy was 27 hours. At 72 hours, 6,627 (25.0%) patients remained on vasopressors. The mean hourly MAP was 72 mmHg in the first six hours, then steadily increased to ≈75 mmHg at 72 hours. In the first 72 hours, 11,032 (41.6%) patients had a mean MAP of 70-74 mmHg, and 5,914 (22.3%) had a mean MAP of 75-79 mmHg. For every clinical subgroup, a MAP of 70-74 mmHg was the most common mean MAP, and the proportion of patients with a mean MAP of 60-65mmHg was less than 5%.

Conclusions

In a large, multicenter study of heterogeneous critically ill patients on vasopressors, the mean hourly MAP was > 70 mmHg. This mean hourly MAP was observed consistently over diverse clinical subgroups and is higher than recommended by guidelines.

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.