Optimal mean arterial pressure and its objective statistical associations with clinical outcomes and multimodal monitoring cerebral physiology: A systematic scoping review.

Optimal mean arterial pressure (MAPopt), also known as optimal arterial blood pressure (ABPopt), represents a patient-specific blood pressure range at which cerebral autoregulation is most intact. To date, literature on this personalized physiological target remains heterogeneous, scattered, and difficult to follow. This scoping review, following PRISMA-ScR guidelines, examined studies that explored objective statistical associations between MAPopt and clinical outcomes and multimodal monitoring (MMM) cerebral physiology. Fifteen articles met the inclusion criteria for studies investigating the relationship between MAPopt and outcome, including seven neonatal studies, five cardiac arrest/surgery studies, two general ICU (Intensive Care Unit) studies, and one neurological ICU study. Fourteen of the fifteen studies found that maintaining blood pressure above or within MAPopt was linked to improved neurological outcomes, while pressures below MAPopt correlated with worse outcomes. In neonates with hypoxic-ischemic encephalopathy, deviations below MAPopt were associated with more severe brain injury. Similarly, cardiac arrest patients spending more time below MAPopt-5 mmHg had higher mortality. Only one study evaluated MAPopt in relation to MMM data, identifying a nonlinear relationship between brain oxygenation and MAP deviation. This review underscores the need for further standardized research on MAPopt, particularly its interaction with MMM, to support its application in personalized critical care.