ArticleAnnals of intensive care2018
Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database.
Article in Annals of intensive care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 5 of them syntheses that pooled it.
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Who cites it
74 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Closed-loop vasopressor systems for hemodynamic control in perioperative and critical care settings: a systematic review and meta-analysis.Journal of clinical monitoring and computing · 2026Pooled 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
- Association of noradrenaline dose with mortality in critically ill patients: a systematic review and dose-response meta-analysis.Critical care (London, England) · 2025Pooled it
- Early management of adult sepsis and septic shock: Korean clinical practice guidelines.Acute and critical care · 2024Guideline
- Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis.Intensive care medicine · 2024Pooled it
- Control of mean arterial pressure using a closed-loop system for norepinephrine infusion in severe brain injury patients: the COMAT randomized controlled trial.Journal of clinical monitoring and computing · 2024Trial
- Initiating angiotensin II at lower vasopressor doses in vasodilatory shock: an exploratory post-hoc analysis of the ATHOS-3 clinical trial.Critical care (London, England) · 2023Trial
- Continual hemodynamic monitoring with a single-use transesophageal echocardiography probe in critically ill patients with shock: a randomized controlled clinical trial.Intensive care medicine · 2019Trial
- Controlled hypotension therapy with isosorbide dinitrate for postoperative bleeding of transurethral resection of the prostate.International journal of surgery case reports · 2026Article
- 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
- Current and future strategies aiming at reducing catecholamine exposure in septic shock.Critical care (London, England) · 2026Review
- Optimizing Timing and Dose of Starting Norepinephrine and Vasopressin in Septic Shock.Life (Basel, Switzerland) · 2026Review
- Association between initial norepinephrine dose and minute by minute mean arterial pressure.Critical care (London, England) · 2026Observational
- 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
- Mean arterial pressure at the initiation of continuous renal replacement therapy as a prognostic indicator in patients with acute kidney injury.Renal failure · 2025Observational
- Ability of the hypotension prediction index to predict hypotension in patients with septic shock in the intensive care unit.Scientific reports · 2025Article
- Unsupervised clustering based on a graph attention network reveals high-risk subgroups among ICU dementia patients for enhanced mortality prediction.European journal of medical research · 2025Article
- Vasoactive Agents in Burn Patients: Perspectives on Angiotensin-II.Journal of burn care & research : official publication of the American Burn Association · 2025Review
- Fluid management strategies in critically ill patients with ARDS: a narrative review.European journal of medical research · 2025Review
- The association of sepsis bundle compliance with mortality in patients with ICU-acquired sepsis: a cohort study.BMC infectious diseases · 2025Article
14 more citing papers are in PubMed but not listed here.
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Authors and funding
9 authors.
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Abstract
backgroundMaintenance of mean arterial pressure (MAP) at levels sufficient to avoid tissue hypoperfusion is a key tenet in the management of distributive shock. We hypothesized that patients with distributive shock sometimes have a MAP below that typically recommended and that such hypotension is associated with increased mortality.
methodsIn this retrospective analysis of the Medical Information Mart for Intensive Care (MIMIC-III) database from Beth Israel Deaconess Medical Center, Boston, USA, we included all intensive care unit (ICU) admissions between 2001 and 2012 with distributive shock, defined as continuous vasopressor support for ≥ 6 h and no evidence of low cardiac output shock. Hypotension was evaluated using five MAP thresholds: 80, 75, 65, 60 and 55 mmHg. We evaluated the longest continuous episode below each threshold during vasopressor therapy. The primary outcome was ICU mortality.
resultsOf 5347 patients with distributive shock, 95.7%, 91.0%, 62.0%, 36.0% and 17.2%, respectively, had MAP < 80, < 75, < 65, < 60 and < 55 mmHg for more than two consecutive hours. On average, ICU mortality increased by 1.3, 1.8, 5.1, 7.9 and 14.4 percentage points for each additional 2 h with MAP < 80, < 75, < 65, < 60 and < 55 mmHg, respectively. Multivariable logistic modeling showed that, compared to patients in whom MAP was never < 65 mmHg, ICU mortality increased as duration of hypotension < 65 mmHg increased [for > 0 to < 2 h, odds ratio (OR) 1.76, p = 0.005; ≥ 6 to < 8 h, OR 2.90, p < 0.0001; ≥ 20 h, OR 7.10, p < 0.0001]. When hypotension was defined as MAP < 60 or < 55 mmHg, the associations between duration and mortality were generally stronger than when hypotension was defined as MAP < 65 mmHg. There was no association between hypotension and mortality when hypotension was defined as MAP < 80 mmHg.
conclusionsWithin the limitations due to the nature of the study, most patients with distributive shock experienced at least one episode with MAP < 65 mmHg lasting > 2 h. Episodes of prolonged hypotension were associated with higher mortality.
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