Evidence map›Paper›PMID 26891677›Full record

Trial reportIntensive care medicine2016

Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial.

François Lamontagne, Maureen O Meade, Paul C Hébert, Pierre Asfar, François Lauzier, Andrew J E Seely, Andrew G Day, Sangeeta Mehta, John Muscedere, Sean M Bagshaw and 18 more

Registry-linked trialAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06476613 (Pilot Study- Permissive Hypotension After Cardiac Surgery), which is not on this map. Cited by 93 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
93citing papers in PubMed, 14 pooled it
18.2field-weighted citation impact, top 1% of its field
1 · What the graph read from 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.

2 · The registry

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.

NCT06476613 nacompletednot on this mapstarted 2024, after this paper: background citation

Pilot Study- Permissive Hypotension After Cardiac Surgery

TypeinterventionalSponsorMassachusetts General HospitalRan2024 to 2026Enrolled80ConditionsSurgeryArmsPermissive Hypotension
3 · Its place in the literature

Who cites it

93 citing papers in PubMed, 14 syntheses or guidelines pooled it, 242 citations in OpenAlex.

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  11. [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020
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33 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

28 authors at 15 institutions in 3 countries.

François LamontagneDepartment of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada. francois.lamontagne@usherbrooke.ca.
Maureen O MeadeDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Paul C HébertDepartment of Medicine and Research Centre, Université de Montréal, Montreal, QC, Canada.
Pierre AsfarDepartment of Medical Intensive Care Medicine, University Hospital Angers, Angers, France.
François LauzierDepartment of Medicine, Université Laval, Quebec, QC, Canada.
Andrew J E SeelyThoracic Surgery and Critical Care Medicine, University of Ottawa, Ottawa, ON, Canada.
Andrew G DayClinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.
Sangeeta MehtaInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
John MuscedereDepartment of Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
Sean M BagshawDivision of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Niall D FergusonInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Deborah J CookDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Salmaan KanjiOttawa Hospital Research Institute, Ottawa, ON, Canada.
Alexis F TurgeonDepartment of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec, QC, Canada.
Margaret S HerridgeInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Sanjay SubramanianDepartment of Critical Care Medicine, Mercy St John's Medical Center, St Louis, MO, USA.
Jacques LacroixDepartment of Pediatrics, CHU Sainte-Justine, Université de Montréal, Quebec, Canada.
Neill K J AdhikariInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Damon C ScalesInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Alison Fox-RobichaudDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Yoanna SkrobikMcGill University, Montreal, QC, Canada.
Richard P WhitlockDepartment of Surgery, McMaster University, Hamilton, ON, Canada.
Robert S GreenDepartment of Critical Care, Dalhousie University, Halifax, NS, Canada.
Karen K Y KooDepartment of Critical Care Medicine, Swedish Medical Center, Seattle, WA, USA.
Teddie TanguayCanadian Association of Critical Care Nurses, London, ON, Canada.
Sheldon MagderMcGill University, Montreal, QC, Canada.
Daren K HeylandClinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.
Canadian Critical Care Trials Group.
University of Toronto · CACanadian Nurses Association · CADalhousie University · CAKingston General Hospital · CAMcGill University · CAOttawa Hospital · CASt. John's University · USSunnybrook Health Science Centre · CAUniversity of Alberta · CAUniversity of Ottawa · CACentre Hospitalier Universitaire de Sherbrooke · CAUniversité d'Angers · FRUniversité de Montréal · CAUniversité de Sherbrooke · CAUniversité Laval · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIn shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock.

methodsWe randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60-65 mmHg) versus a higher (75-80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups.

resultsA total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95% CI 7-11). In the lower and higher MAP groups, we observed deviations on 12 versus 8% of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36%, p = 0.07) and hospital mortality (30 versus 33%, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60%, p = 0.03) but not in younger patients.

conclusionsThis pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy.

Indexed as

AdolescentAdultAgedAged, 80 and overArterial PressureFemaleHumansHypotensionMaleMiddle AgedPilot ProjectsShockVasoconstrictor AgentsVasoconstrictor AgentsBlood pressure targetsResuscitationShockVasopressors

Identifiers

PMID26891677
OpenAlexW2287296216

What OpenQuestion holds

Textmetadata
Read underepoch 390

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 OpenQuestion graph.