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sábado, 15 de febrero de 2020

MAP: >65 mm or >60 mm ?

PulmCrit (EMCrit)
PulmCrit - February 15, 2020 - By Josh Farkas
"The 65 trial compares MAP targets of >65 mm to >60 mm in treating vasodilatory hypotension. This trial challenges decades of protocols which have targeted a MAP >65 mm. As such, it is a courageous and practice-changing study. However, we need to be realistic about the study’s limitations...
Summary The Bullet: 
  • The 65 trial randomized ICU patients over 65 years old with vasodilatory shock admitted to ICU to target a MAP of 60-65 versus conventional therapy.
  • Patients in the 60-65 mm arm on average had MAPs ~6 mm below the conventional arm. Fluid utilization was not different between the two groups.
  • Targeting lower MAPs didn’t have a statistically significant effect on mortality, renal function, respiratory function, ICU length of stay, or 90-day cognitive outcomes. Targeting a lower MAP accelerated liberation from vasopressors by an average of 5 hours.
  • This study demonstrates that targeting a MAP >60 mm in ICU patients over age 65 is safe and potentially beneficial within the context of an RCT. However, as with any hemodynamic intervention, careful monitoring is likely important to ensure that patients are responding favorably.·