Surgery ·
OPTIPAM Trial Finds No Clear Benefit From Individualized MAP Targets in Cardiac Surgery
In the OPTIPAM randomized trial, 172 adults undergoing elective cardiac surgery with cardiopulmonary bypass were assigned to individualized or standard mean arterial pressure targets. The trial stopped early after more hemorrhagic complications occurred with individualized management; the primary outcome did not differ significantly between groups.
- Primary composite outcome did not differ significantly between groups.
- Individualized MAP targets were met for 33% of intraoperative time.
- Bleeding complications were more frequent with individualized management.
- Trial stopped early after enrolling 172 patients.
The single-blind, multicenter trial enrolled adults undergoing elective cardiac surgery with cardiopulmonary bypass at 10 tertiary centers in France. Individualized management targeted mean arterial pressure (MAP) within 10% of each patient’s preoperative baseline during surgery and for 24 hours afterward; standard management targeted MAP of at least 65 mm Hg. The primary outcome was death, acute kidney injury, or prespecified neurologic complications within seven days.
The trial enrolled 172 patients and was stopped early by the data and safety monitoring board because of increased bleeding in the individualized group. Mean intraoperative MAP was 80.6 versus 75.6 mm Hg, but the individualized target was met for only 33% of intraoperative time, with greater vasopressor use. The primary outcome occurred in 32% (27/85) versus 29% (25/87; relative risk 1.1, 95% CI 0.7–1.8; P=0.76). Hemorrhagic complications occurred in 18% versus 3% (P=0.003).
Early termination and limited target adherence constrain interpretation; the trial could not determine whether individualized targets reduce major complications. The bleeding difference is a safety signal requiring further study, not proof of causation.
In practice
For adults undergoing elective cardiac surgery with cardiopulmonary bypass, this small randomized trial does not establish that targeting MAP near each patient’s preoperative baseline reduces death, acute kidney injury, or neurologic complications compared with a target of at least 65 mm Hg. The trial stopped early after more hemorrhagic complications were observed with individualized management (18% vs 3%). Early termination, limited adherence to the individualized target, and the wide confidence interval leave benefit and harm uncertain; these findings do not support a practice change on their own.
AI-generated clinical interpretation · Not editor-reviewed
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Anesthesiology: Individualized mean arterial pressure during cardiac surgery The OPTIPAM Randomized Clinical Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.