SynthesisNEJM evidence2025
Blood Pressure Targets for Adults with Vasodilatory Shock - An Individual Patient Data Meta-Analysis.
Synthesis in NEJM evidence, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Mortality effect of higher versus lower blood pressure targets in vasodilatory shock: an updated systematic review and meta-analysis.Critical care (London, England) · 2025Pooled it
- Heterogeneity in the response to a high vs low mean arterial pressure target in patients with septic shock a post hoc analysis of a randomized controlled trial.Intensive care medicine · 2025Trial
- Alarm configuration and adherence to prescribed mean arterial pressure targets in the intensive care unit: A multicentre pre-post evaluation.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Proposed echocardiography-guided flowchart for calcium channel blocker overdose: distinguishing vasoplegia from cardiogenic shock.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2026Review
- Resuscitation Targets, Fluids, and Vasoactives in Septic Shock.Clinics in chest medicine · 2026Review
- Higher Versus Lower Mean Arterial Blood Pressure Targets in Vasodilatory Shock.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Review
- Association between time to target mean arterial pressure and 90-day mortality in septic shock: a post hoc analysis of the OPTPRESS trial.Annals of intensive care · 2026Article
- Five things the intensivist cannot forget in the management of septic shock.Critical care science · 2026Article
- Chronic phase ventilation strategy in established severe bronchopulmonary dysplasia: A critical evaluation of the evidence.SAGE open medicine · 2026Review
- Current and emerging therapeutic options for refractory septic shock: A systematic review.World journal of critical care medicine · 2025Article
- The intricate relationship between capillary refill time and systemic hemodynamics in septic shock.Annals of intensive care · 2025Review
- Individualized mean arterial pressure targets in critically ill patients guided by non-invasive cerebral-autoregulation: a scoping review.Critical care (London, England) · 2025Article
- Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025Article
- Excessive vasopressors or excessive hypotension: Searching for the goldilocks zone in mean arterial pressure targets.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025Article
- Mean arterial pressure in critically ill adults receiving vasopressors: A multicentre, observational study.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025Article
- Vasopressor Therapy.Journal of clinical medicine · 2024Review
Corrections and comments
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Authors and funding
18 authors.
Funding
Abstract
backgroundWe sought to estimate whether a lower mean arterial blood pressure target, compared with a higher mean arterial blood pressure target, reduced 90-day all-cause mortality among critically ill adult patients with vasodilatory shock.
methodsWe conducted an individual patient data meta-analysis of randomized controlled trials that evaluated the effect of distinct thresholds of mean arterial blood pressure to guide vasopressor support among critically ill adults identified in a systematic literature search. The main exposure was a lower mean arterial pressure target compared with a higher mean arterial pressure target (including usual care). The primary outcome was 90-day all-cause mortality. We used a Bayesian random effects log-binomial model to estimate risk ratios with 95% credible intervals (CrIs).
resultsBetween 2010 and 2019, 3352 patients were randomly assigned in three trials (SEPSISPAM, OVATION pilot trial, and 65-Trial) across 103 hospitals from the United Kingdom, France, and Canada. When compared with a higher mean arterial blood pressure target or usual care, the risk ratio for 90-day all-cause mortality associated with a lower blood pressure target was 0.93 (95% CrI, 0.76 to 1.07; low certainty, posterior probability of benefit 87%). Results were consistent across multiple secondary and sensitivity analyses, including adjustment for prognostically important baseline covariates and alternative modeling techniques. Multiple approaches to evaluate the heterogeneity of treatment effect did not identify any subgroups that may potentially benefit from higher mean arterial blood pressure targets.
conclusionsTargeting a lower mean arterial blood pressure for vasopressor therapy in critically ill patients with vasodilatory shock possibly reduced 90-day all-cause mortality. However, the certainty of evidence is low, and this analysis does not exclude the possibility that lower targets may cause harm overall.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.