65 Trial Summary: Vasopressors in Older Critically Ill Patients

65 trial summary vasopressors

2020 65 TRIAL Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Critically III patients Multicenter, pragmatic, randomized clinical trial Objective: To evaluate the effect on mortality at 90 days of reducing the exposure to vasopressors through permissive hypotension (mean arterial pressure target of 60-65 mm Hg) in intensive care unit (ICU) patients. 2,600 patients Inclusion criteria: Patients > 65 years; <6 hours since commencing vasopressor infusion; adequately fluid resuscitated; Vasopressors were expected to continue for at least 6 hours more MAP target (60-65 mm Hg, permissive hypotension) (n = 1291] VS Usual care (at the discretion of treating clinicians) (n = 1307] PRIMARY OUTCOME 41.0 all-cause mortality at 90 days % absolute risk difference, -2.85%; 95% CI, -6.75 to 1.05; P=.15 43.8 38.2 primary ourcome in chronic hypertension subgroup % adjusted OR 0.67, 95% C.I. 0.49-0.85 44.3 SECONDARY OUTCOME 5.8 Serious adverse events % 6.2 limitation: unblinded, trial was not powered to detect difference in subgroup analysis Conclusion: In patients older than 65 years receiving vasopressors for vasodilatory shock there was no difference in 90 day mortality but the point estimate for the primary outcome favours permissive hypotension. Fran├žois Lamontagne et al. JAMA. 2020;323(10):938-949.