title: High versus low blood-pressure target in patients with septic shock.
abstract: BACKGROUND
  The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown.
  
  
  METHODS
  In a multicenter, open-label trial, we randomly assigned 776 patients with septic shock to undergo resuscitation with a mean arterial pressure target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). The primary end point was mortality at day 28.
  
  
  RESULTS
  At 28 days, there was no significant between-group difference in mortality, with deaths reported in 142 of 388 patients in the high-target group (36.6%) and 132 of 388 patients in the low-target group (34.0%) (hazard ratio in the high-target group, 1.07; 95% confidence interval [CI], 0.84 to 1.38; P=0.57). There was also no significant difference in mortality at 90 days, with 170 deaths (43.8%) and 164 deaths (42.3%), respectively (hazard ratio, 1.04; 95% CI, 0.83 to 1.30; P=0.74). The occurrence of serious adverse events did not differ significantly between the two groups (74 events [19.1%] and 69 events [17.8%], respectively; P=0.64). However, the incidence of newly diagnosed atrial fibrillation was higher in the high-target group than in the low-target group. Among patients with chronic hypertension, those in the high-target group required less renal-replacement therapy than did those in the low-target group, but such therapy was not associated with a difference in mortality.
  
  
  CONCLUSIONS
  Targeting a mean arterial pressure of 80 to 85 mm Hg, as compared with 65 to 70 mm Hg, in patients with septic shock undergoing resuscitation did not result in significant differences in mortality at either 28 or 90 days. (Funded by the French Ministry of Health; SEPSISPAM ClinicalTrials.gov number, NCT01149278.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: Pierre
authors.initials: P
authors.lastname: Asfar
authors.forename: Ferhat
authors.initials: F
authors.lastname: Meziani
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Hamel
authors.forename: Fabien
authors.initials: F
authors.lastname: Grelon
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.forename: Nadia
authors.initials: N
authors.lastname: Anguel
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Dequin
authors.forename: Soizic
authors.initials: S
authors.lastname: Gergaud
authors.forename: Nicolas
authors.initials: N
authors.lastname: Weiss
authors.forename: François
authors.initials: F
authors.lastname: Legay
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.forename: Marie
authors.initials: M
authors.lastname: Conrad
authors.forename: René
authors.initials: R
authors.lastname: Robert
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gonzalez
authors.forename: Christophe
authors.initials: C
authors.lastname: Guitton
authors.forename: Fabienne
authors.initials: F
authors.lastname: Tamion
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tonnelier
authors.forename: Pierre
authors.initials: P
authors.lastname: Guezennec
authors.forename: Thierry
authors.initials: T
authors.lastname: Van Der Linden
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
authors.forename: Eric
authors.initials: E
authors.lastname: Mariotte
authors.forename: Gaël
authors.initials: G
authors.lastname: Pradel
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesieur
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.forename: Fabien
authors.initials: F
authors.lastname: Hervé
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
authors.forename: Claude
authors.initials: C
authors.lastname: Guerin
authors.forename: Alain
authors.initials: A
authors.lastname: Mercat
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
authors.forename: Peter
authors.initials: P
authors.lastname: Radermacher
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D001794:Blood Pressure; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods*; D012772:Shock, Septic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents