Trial reportIntensive care medicine2025
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.
Trial report in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01149278 (Assessment of Two Levels of Arterial Pressure on Survival in Patients With Septic Shock), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.
What it found
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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.
Assessment of Two Levels of Arterial Pressure on Survival in Patients With Septic Shock
Who cites it
9 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
- Impact of continuing renin-angiotensin-aldosterone system inhibitors before surgery on intraoperative hypotensive events: a secondary analysis of the STOP-or-NOT Trial.British journal of anaesthesia · 2026Trial
- Mean arterial pressure-to-norepinephrine-equivalent dose ratio, rather than achieved mean arterial pressure alone, is associated with mortality in septic shock.Journal of intensive care · 2026Article
- Update on sepsis and septic shock: from bundles to precision medicine.Intensive care medicine · 2026Article
- 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
- Article
- Beyond statistical heterogeneity: physiological individualization in septic shock resuscitation. Authors' Reply.Intensive care medicine · 2025Article
- Update on acute kidney injury: some progresses and a long way to go.Intensive care medicine · 2025Article
- Beyond statistical heterogeneity: physiological individualization in septic shock resuscitation.Intensive care medicine · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
Abstract
backgroundThe best blood pressure target in sepsis is a matter of debate. SEPSIS-PAM, a large multicenter pragmatic randomized controlled trial, compared two mean arterial pressure targets (65-70 mmHg vs 80-85 mmHg) in septic shock and did not find any difference in mortality. The goal of this study was to assess whether (i) heterogeneity of treatment effect (HTE) exists in the response to different targets and (ii) the initial clinical trajectory can inform the optimal blood pressure target.
methodsThe primary outcome was mortality at day 28. Secondary outcomes included mortality at day 90, acute kidney injury (AKI), and severe AKI based on the KDIGO classification, need for renal replacement therapy, renal replacement therapy, and vasopressor-free days. The presence of HTE was tested for and, if present, quantified. The interaction between post-randomization evolution of the MAP, norepinephrine requirements, lactate, mottling score, and urine output was estimated using a multimediation analysis.
results776 patients were enrolled and analyzed in this study. There was no evidence of significant treatment effect heterogeneity based on baseline characteristics (sweep p-value = 0.664; 95% CI: 0.633-0.673). The direct effect of a higher MAP target on mortality, holding 24 h mediators at their control-level values, was not significant (RD = 0.017; 95% CI - 0.052 to 0.086; p = 0.62). However, if reaching a higher MAP required high norepinephrine doses and/or did not result in mottled skin resolution at 24 h, the effect transmitted through those mediators was associated with higher mortality (risk difference = 0.027; 95% CI 0.012-0.047 and 0.012; 95% CI 0.001-0.026).
conclusionOur results suggest the absence of heterogeneity of the response to different blood pressure targets in patients with septic shock. Targeting a higher MAP target may be associated with harm when high norepinephrine doses are required or when mottled skin is present.
trial registrationSEPSISPAM ClinicalTrials.gov number, NCT01149278.
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