No Mortality Benefit from a Higher MAP Target in Septic Patients

A target mean arterial pressure of 80 to 85 mm Hg conferred no mortality benefit over the standard 65 to 70 mm Hg target.

Current sepsis guidelines recommend using fluids and vasopressors to maintain a mean arterial pressure (MAP) target of at least 65 mm Hg in patients with septic shock, as part of a sepsis treatment bundle that has been shown to confer a mortality benefit (NEJM Journal Watch Emerg Med Feb 22 2013 and NEJM Journal Watch Emerg Med Sep 7 2012). However, it is unknown whether a higher MAP target might improve mortality and decrease end-organ dysfunction. In a 29-center French study, researchers compared outcomes in 776 patients with septic shock who were randomized to MAP targets of either 65 to 70 mm Hg or 80 to 85 mm Hg.

The actual measured range of MAP values was about 5 mm Hg higher than the target ranges in both groups. There were no significant differences between the low-target and high-target groups in 28-day mortality (34% and 37%), 90-day mortality (42% and 44%), or median intensive care unit length of stay (8 days in both groups). However, the high-target group was more likely to develop atrial fibrillation and among patients with chronic hypertension, those in the high-target group were less likely to require dialysis.

COMMENT

A higher MAP target was not associated with decreased mortality in this study. Although patients with septic shock who have chronic hypertension may be less likely to need dialysis if a higher MAP is targeted, this benefit may be offset by an increased risk for atrial fibrillation. The findings in this study should not change our practice. The current guideline-recommended MAP target of at least 65 mm Hg for patients in septic shock is still appropriate.