Hemodynamics, fluids & transfusion
High–normal versus low–normal mean arterial pressure thresholds in critically ill patients: a systematic review and meta-analysis of randomized trials
Authors' conclusion
This updated systematic review and meta-analysis of RCTs found no differences in mortality, favourable neurologic outcome, or the need for renal replacement therapy between critically ill patients assigned to a high-normal vs low-normal MAP target.
Study context
- Population
- Critically ill patients (OHCA, distributive shock requiring vasopressors, septic shock, hepatorenal syndrome)
- Participants
- 4,561 patients · 8 randomized controlled trials (RCTs)
- Comparison
- High-normal vs low-normal mean arterial pressure (MAP) threshold
- Outcome
- Mortality, high-normal vs low-normal MAP
Methodological detailsGRADE certainty assessment, Cochrane risk-of-bias 2 tool, Six databases searched from inception until 1 October 2022
- GRADE certainty assessment
- Cochrane risk-of-bias 2 tool
- Six databases searched from inception until 1 October 2022
Pooled result
As reported in the abstract
Pooled RR for mortality (8 RCTs; 4,439 patients)
1.06
95% CI 0.99 to 1.14
Further pooled results
Favourable neurologic outcome, high-normal vs low-normal MAP
- Pooled RR for favourable neurologic outcome (4 RCTs; 1,065 patients)
- 0.99 (95% CI, 0.90 to 1.08)
- Moderate certainty
Need for RRT, high-normal vs low-normal MAP
- RR for need for RRT (4 RCTs; 4,071 patients)
- 0.97 (95% CI, 0.87 to 1.08)
- Moderate certainty
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
High–normal versus low–normal mean arterial pressure thresholds in critically ill patients: a systematic review and meta-analysis of randomized trials. Can J Anaesth. Published 2 June 2023. doi:10.
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