Saturday, July 18, 2020

Permissive hypotension in sepsis

Q: What was the target Mean Arterial Pressure (MAP) in the "permissive hypotension" group in the “65 trial” study?

A) 60-65 mm Hg
B) 65-70 mm Hg

Answer: A

A randomized controlled trial was published in 2020 to evaluate the effect of reduced exposure to vasopressors on 90-day mortality in older critically ill patients with vasodilatory hypotension. It was a multicenter trial conducted in UK's 65 ICUs and included 2600 randomized patients aged 65 years or older with vasodilatory hypotension. Patients were randomized 1:1 to vasopressors guided either by MAP target 60-65 mm Hg(permissive hypotension group) or according to usual care at the discretion of treating clinicians. Although the permissive hypotension group did not show a statistically significant reduction in mortality at 90 days, the data pointed towards benefit with the odds ratio for 90-day mortality of 0.82 (95% CI, 0.68 to 0.98). Moreover, there were no differences in the rates of cognitive dysfunction, arrhythmias, or acute kidney injury (AKI).



Lamontagne F, Richards-Belle A, Thomas K, et al. Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial. JAMA 2020.

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