Pediatrics · 7 h ago
Permissive Blood Pressure Targets Reduce Vasoactive Exposure Without Improving Primary Pediatric ICU Outcome
A pragmatic randomized trial involving 1,900 critically ill children found that a permissive mean arterial pressure target reduced vasoactive drug exposure but did not significantly improve the composite of mortality and invasive ventilation duration at 30 days. Kidney replacement therapy use and adverse events did not differ from usual care.
- Trial randomized 1,900 ventilated children receiving vasoactive drugs for hypotension.
- Permissive targeting reduced median norepinephrine-equivalent total dose by 37.5%.
- Mortality–ventilation composite did not differ significantly at 30 days.
- Kidney replacement therapy use and adverse events were similar.
Optimal mean arterial pressure (MAP) targets for hypotensive critically ill children remain uncertain. An unblinded, pragmatic randomized trial across 23 pediatric intensive care units (PICUs) in three countries enrolled 1,900 children receiving invasive ventilation and vasoactive drugs. Participants were assigned to a permissive MAP target above the fifth percentile for age or usual care, with targets set by the attending physician. The primary outcome combined mortality and duration of invasive ventilation at 30 days.
The primary analysis included 1,814 children; participants had a median age of 4 years, and 44.8% were female. Median MAP during vasoactive treatment was 58 mm Hg with permissive targeting versus 61 mm Hg with usual care. The permissive strategy reduced the median norepinephrine-equivalent total dose by 37.5%, but the primary outcome did not differ significantly (probabilistic index, 0.52; 95% CI, 0.49-0.54; P = .23). Six of seven secondary outcomes were similar. Among survivors, median PICU stay was significantly shorter with permissive targeting: 159 versus 166 hours. Kidney replacement therapy use and adverse events did not differ.
These findings demonstrate reduced vasoactive exposure without a demonstrated benefit in the primary clinical outcome; they do not establish equivalence between strategies. Interpretation should account for the unblinded design, incomplete primary-outcome analysis population, and the isolated secondary finding for PICU stay. Only the abstract was available for this update.
Is this summary clinically accurate?
Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.
Sign in to rate this summary →Source
JAMA: Permissive Blood Pressure Targets in Pediatric Critical Care ↗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.