J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 5, May 2022, pages 196-201

Mean Arterial Pressure Goal in Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials

Figure 1. Forest plot showing risk ratio of overall mortality. MAP: mean arterial pressure; CI: confidence interval.

Figure 2. Forest plot showing risk ratio of the duration of mechanical ventilation. MAP: mean arterial pressure; CI: confidence interval.

Figure 3. Forest plot showing risk ratio of ICU length of stay. MAP: mean arterial pressure; CI: confidence interval; ICU: intensive care unit.

Figure 4. Forest plot showing ICU length of stay by subgroup analysis. MAP: mean arterial pressure; CI: confidence interval; ICU: intensive care unit.

Figure 5. Forest plot showing mortality by subgroup analysis. MAP: mean arterial pressure; CI: confidence interval.

Figure 6. Forest plot showing duration of mechanical ventilation by subgroup analysis. MAP: mean arterial pressure; CI: confidence interval.

**Table 1.** Baseline Characteristics of the Patients and Characteristics of Trials Included
Study (year)	N (patients^a)	Follow-up (months)	Major inclusion criteria	Major exclusion criteria	Age (years ± SD)/range	MAP target (mm Hg)
^a)Number of patients include all the patients initially randomized in trial. H: high mean arterial pressure; S: standard mean arterial pressure; OHCA: out-of-hospital cardiac arrest; VT: ventricular tachycardia; VF: ventricular fibrillation; MAP: mean arterial pressure; SD: standard deviation; CABG: coronary artery bypass grafting.
Afsar et al, 2014 (SEPSISPAM) [13]	H: 388	3	Septic shock refractory to fluid resuscitation, vasopressor use < 6 h	Pregnancy, decision not to resuscitate	H: 65 ± 13	H: 80 - 85
	S: 388				S: 65 ± 15	S: 65 - 70
Lamontagne et al, 2016 (OVATION) [14]	H: 58	1	Vasodilatory shock, adequate fluid resuscitation, vasopressor use ≥ 6 h	Vasopressors ≥ 24 h, expected to die within 48 h, other shock etiology	H: 63 ± 13	H: 75 - 80
	S: 60				S: 66 ± 13	S: 60 - 65
Lamontagne et al, 2020 (65 Trial) [15]	H: 1,300	3	Vasodilatory shock, adequate fluid resuscitation, vasopressor use ≥ 6 h	Vasopressors use for bleeding, cardiac failure, post-CABGs vasoplegia, brain or spinal cord injury	H: 74.8 (70.1 - 80.8)	H: > 70
	S: 1,283				S: 75.2 (70.4 - 80.5)	S: 60 - 70
Jakkula et al, 2018 (COMACARE) [17]	H: 60	6	Resuscitation after VT or VF OHCA	Intracranial pathology, severe respiratory failure	H: 58 ± 14	H: 80 - 100
	S: 60				S: 61 ± 11	S: 65 - 75
Ameloot et al, 2019 (Neuroprotect) [16]	H: 52	6	Resuscitated OHCA from presumed cardiac cause	Intracranial pathology, refractory shock on vasopressors	H: 64 ± 12	H: 85 - 100
	S: 55				S: 65 ± 13	S: 65
Grand et al, 2020 [18]	H: 23	6	Resuscitated OHCA from presumed cardiac cause	Unwitnessed OHCA asystole primary rhythm, intracranial pathology	H: 63 ± 10	H: 72
	S: 26				S: 59 ± 13	S: 65

Table 1. Baseline Characteristics of the Patients and Characteristics of Trials Included

Study (year)

N (patients^a)

Follow-up (months)

Major inclusion criteria

Major exclusion criteria

Age (years ± SD)/range

MAP target (mm Hg)

^a)Number of patients include all the patients initially randomized in trial. H: high mean arterial pressure; S: standard mean arterial pressure; OHCA: out-of-hospital cardiac arrest; VT: ventricular tachycardia; VF: ventricular fibrillation; MAP: mean arterial pressure; SD: standard deviation; CABG: coronary artery bypass grafting.

Afsar et al, 2014 (SEPSISPAM) [13]

H: 388

Septic shock refractory to fluid resuscitation, vasopressor use < 6 h

Pregnancy, decision not to resuscitate

H: 65 ± 13

H: 80 - 85

S: 388

S: 65 ± 15

S: 65 - 70

Lamontagne et al, 2016 (OVATION) [14]

H: 58

Vasodilatory shock, adequate fluid resuscitation, vasopressor use ≥ 6 h

Vasopressors ≥ 24 h, expected to die within 48 h, other shock etiology

H: 63 ± 13

H: 75 - 80

S: 60

S: 66 ± 13

S: 60 - 65

Lamontagne et al, 2020 (65 Trial) [15]

H: 1,300

Vasodilatory shock, adequate fluid resuscitation, vasopressor use ≥ 6 h

Vasopressors use for bleeding, cardiac failure, post-CABGs vasoplegia, brain or spinal cord injury

H: 74.8 (70.1 - 80.8)

H: > 70

S: 1,283

S: 75.2 (70.4 - 80.5)

S: 60 - 70

Jakkula et al, 2018 (COMACARE) [17]

H: 60

Resuscitation after VT or VF OHCA

Intracranial pathology, severe respiratory failure

H: 58 ± 14

H: 80 - 100

S: 60

S: 61 ± 11

S: 65 - 75

Ameloot et al, 2019 (Neuroprotect) [16]

H: 52

Resuscitated OHCA from presumed cardiac cause

Intracranial pathology, refractory shock on vasopressors

H: 64 ± 12

H: 85 - 100

S: 55

S: 65 ± 13

S: 65

Grand et al, 2020 [18]

H: 23

Resuscitated OHCA from presumed cardiac cause

Unwitnessed OHCA asystole primary rhythm, intracranial pathology

H: 63 ± 10

H: 72

S: 26

S: 59 ± 13

S: 65