Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial
Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopr...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Lamontagne, François [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2016 |
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| Schlagwörter: |
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| Anmerkung: |
© Springer-Verlag Berlin Heidelberg and ESICM 2016 |
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| Übergeordnetes Werk: |
Enthalten in: Intensive care medicine - Berlin : Springer, 1975, 42(2016), 4 vom: 18. Feb., Seite 542-550 |
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| Übergeordnetes Werk: |
volume:42 ; year:2016 ; number:4 ; day:18 ; month:02 ; pages:542-550 |
| Links: |
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| DOI / URN: |
10.1007/s00134-016-4237-3 |
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| Katalog-ID: |
SPR001233645 |
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| 041 | |a eng | ||
| 100 | 1 | |a Lamontagne, François |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial |
| 264 | 1 | |c 2016 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a © Springer-Verlag Berlin Heidelberg and ESICM 2016 | ||
| 520 | |a Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. | ||
| 650 | 4 | |a Vasopressors |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Shock |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Blood pressure targets |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Resuscitation |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Meade, Maureen O. |4 aut | |
| 700 | 1 | |a Hébert, Paul C. |4 aut | |
| 700 | 1 | |a Asfar, Pierre |4 aut | |
| 700 | 1 | |a Lauzier, François |4 aut | |
| 700 | 1 | |a Seely, Andrew J.E. |4 aut | |
| 700 | 1 | |a Day, Andrew G. |4 aut | |
| 700 | 1 | |a Mehta, Sangeeta |4 aut | |
| 700 | 1 | |a Muscedere, John |4 aut | |
| 700 | 1 | |a Bagshaw, Sean M. |4 aut | |
| 700 | 1 | |a Ferguson, Niall D. |4 aut | |
| 700 | 1 | |a Cook, Deborah J. |4 aut | |
| 700 | 1 | |a Kanji, Salmaan |4 aut | |
| 700 | 1 | |a Turgeon, Alexis F. |4 aut | |
| 700 | 1 | |a Herridge, Margaret S. |4 aut | |
| 700 | 1 | |a Subramanian, Sanjay |4 aut | |
| 700 | 1 | |a Lacroix, Jacques |4 aut | |
| 700 | 1 | |a Adhikari, Neill K.J. |4 aut | |
| 700 | 1 | |a Scales, Damon C. |4 aut | |
| 700 | 1 | |a Fox-Robichaud, Alison |4 aut | |
| 700 | 1 | |a Skrobik, Yoanna |4 aut | |
| 700 | 1 | |a Whitlock, Richard P. |4 aut | |
| 700 | 1 | |a Green, Robert S. |4 aut | |
| 700 | 1 | |a Koo, Karen K.Y. |4 aut | |
| 700 | 1 | |a Tanguay, Teddie |4 aut | |
| 700 | 1 | |a Magder, Sheldon |4 aut | |
| 700 | 1 | |a Heyland, Daren K. |4 aut | |
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10.1007/s00134-016-4237-3 doi (DE-627)SPR001233645 (SPR)s00134-016-4237-3-e DE-627 ger DE-627 rakwb eng Lamontagne, François verfasserin aut Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag Berlin Heidelberg and ESICM 2016 Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. Vasopressors (dpeaa)DE-He213 Shock (dpeaa)DE-He213 Blood pressure targets (dpeaa)DE-He213 Resuscitation (dpeaa)DE-He213 Meade, Maureen O. aut Hébert, Paul C. aut Asfar, Pierre aut Lauzier, François aut Seely, Andrew J.E. aut Day, Andrew G. aut Mehta, Sangeeta aut Muscedere, John aut Bagshaw, Sean M. aut Ferguson, Niall D. aut Cook, Deborah J. aut Kanji, Salmaan aut Turgeon, Alexis F. aut Herridge, Margaret S. aut Subramanian, Sanjay aut Lacroix, Jacques aut Adhikari, Neill K.J. aut Scales, Damon C. aut Fox-Robichaud, Alison aut Skrobik, Yoanna aut Whitlock, Richard P. aut Green, Robert S. aut Koo, Karen K.Y. aut Tanguay, Teddie aut Magder, Sheldon aut Heyland, Daren K. aut Enthalten in Intensive care medicine Berlin : Springer, 1975 42(2016), 4 vom: 18. Feb., Seite 542-550 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:42 year:2016 number:4 day:18 month:02 pages:542-550 https://dx.doi.org/10.1007/s00134-016-4237-3 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 42 2016 4 18 02 542-550 |
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10.1007/s00134-016-4237-3 doi (DE-627)SPR001233645 (SPR)s00134-016-4237-3-e DE-627 ger DE-627 rakwb eng Lamontagne, François verfasserin aut Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag Berlin Heidelberg and ESICM 2016 Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. Vasopressors (dpeaa)DE-He213 Shock (dpeaa)DE-He213 Blood pressure targets (dpeaa)DE-He213 Resuscitation (dpeaa)DE-He213 Meade, Maureen O. aut Hébert, Paul C. aut Asfar, Pierre aut Lauzier, François aut Seely, Andrew J.E. aut Day, Andrew G. aut Mehta, Sangeeta aut Muscedere, John aut Bagshaw, Sean M. aut Ferguson, Niall D. aut Cook, Deborah J. aut Kanji, Salmaan aut Turgeon, Alexis F. aut Herridge, Margaret S. aut Subramanian, Sanjay aut Lacroix, Jacques aut Adhikari, Neill K.J. aut Scales, Damon C. aut Fox-Robichaud, Alison aut Skrobik, Yoanna aut Whitlock, Richard P. aut Green, Robert S. aut Koo, Karen K.Y. aut Tanguay, Teddie aut Magder, Sheldon aut Heyland, Daren K. aut Enthalten in Intensive care medicine Berlin : Springer, 1975 42(2016), 4 vom: 18. Feb., Seite 542-550 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:42 year:2016 number:4 day:18 month:02 pages:542-550 https://dx.doi.org/10.1007/s00134-016-4237-3 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 42 2016 4 18 02 542-550 |
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10.1007/s00134-016-4237-3 doi (DE-627)SPR001233645 (SPR)s00134-016-4237-3-e DE-627 ger DE-627 rakwb eng Lamontagne, François verfasserin aut Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag Berlin Heidelberg and ESICM 2016 Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. Vasopressors (dpeaa)DE-He213 Shock (dpeaa)DE-He213 Blood pressure targets (dpeaa)DE-He213 Resuscitation (dpeaa)DE-He213 Meade, Maureen O. aut Hébert, Paul C. aut Asfar, Pierre aut Lauzier, François aut Seely, Andrew J.E. aut Day, Andrew G. aut Mehta, Sangeeta aut Muscedere, John aut Bagshaw, Sean M. aut Ferguson, Niall D. aut Cook, Deborah J. aut Kanji, Salmaan aut Turgeon, Alexis F. aut Herridge, Margaret S. aut Subramanian, Sanjay aut Lacroix, Jacques aut Adhikari, Neill K.J. aut Scales, Damon C. aut Fox-Robichaud, Alison aut Skrobik, Yoanna aut Whitlock, Richard P. aut Green, Robert S. aut Koo, Karen K.Y. aut Tanguay, Teddie aut Magder, Sheldon aut Heyland, Daren K. aut Enthalten in Intensive care medicine Berlin : Springer, 1975 42(2016), 4 vom: 18. Feb., Seite 542-550 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:42 year:2016 number:4 day:18 month:02 pages:542-550 https://dx.doi.org/10.1007/s00134-016-4237-3 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 42 2016 4 18 02 542-550 |
| allfieldsGer |
10.1007/s00134-016-4237-3 doi (DE-627)SPR001233645 (SPR)s00134-016-4237-3-e DE-627 ger DE-627 rakwb eng Lamontagne, François verfasserin aut Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag Berlin Heidelberg and ESICM 2016 Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. Vasopressors (dpeaa)DE-He213 Shock (dpeaa)DE-He213 Blood pressure targets (dpeaa)DE-He213 Resuscitation (dpeaa)DE-He213 Meade, Maureen O. aut Hébert, Paul C. aut Asfar, Pierre aut Lauzier, François aut Seely, Andrew J.E. aut Day, Andrew G. aut Mehta, Sangeeta aut Muscedere, John aut Bagshaw, Sean M. aut Ferguson, Niall D. aut Cook, Deborah J. aut Kanji, Salmaan aut Turgeon, Alexis F. aut Herridge, Margaret S. aut Subramanian, Sanjay aut Lacroix, Jacques aut Adhikari, Neill K.J. aut Scales, Damon C. aut Fox-Robichaud, Alison aut Skrobik, Yoanna aut Whitlock, Richard P. aut Green, Robert S. aut Koo, Karen K.Y. aut Tanguay, Teddie aut Magder, Sheldon aut Heyland, Daren K. aut Enthalten in Intensive care medicine Berlin : Springer, 1975 42(2016), 4 vom: 18. Feb., Seite 542-550 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:42 year:2016 number:4 day:18 month:02 pages:542-550 https://dx.doi.org/10.1007/s00134-016-4237-3 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 42 2016 4 18 02 542-550 |
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10.1007/s00134-016-4237-3 doi (DE-627)SPR001233645 (SPR)s00134-016-4237-3-e DE-627 ger DE-627 rakwb eng Lamontagne, François verfasserin aut Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag Berlin Heidelberg and ESICM 2016 Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. Vasopressors (dpeaa)DE-He213 Shock (dpeaa)DE-He213 Blood pressure targets (dpeaa)DE-He213 Resuscitation (dpeaa)DE-He213 Meade, Maureen O. aut Hébert, Paul C. aut Asfar, Pierre aut Lauzier, François aut Seely, Andrew J.E. aut Day, Andrew G. aut Mehta, Sangeeta aut Muscedere, John aut Bagshaw, Sean M. aut Ferguson, Niall D. aut Cook, Deborah J. aut Kanji, Salmaan aut Turgeon, Alexis F. aut Herridge, Margaret S. aut Subramanian, Sanjay aut Lacroix, Jacques aut Adhikari, Neill K.J. aut Scales, Damon C. aut Fox-Robichaud, Alison aut Skrobik, Yoanna aut Whitlock, Richard P. aut Green, Robert S. aut Koo, Karen K.Y. aut Tanguay, Teddie aut Magder, Sheldon aut Heyland, Daren K. aut Enthalten in Intensive care medicine Berlin : Springer, 1975 42(2016), 4 vom: 18. Feb., Seite 542-550 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:42 year:2016 number:4 day:18 month:02 pages:542-550 https://dx.doi.org/10.1007/s00134-016-4237-3 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 42 2016 4 18 02 542-550 |
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Lamontagne, François @@aut@@ Meade, Maureen O. @@aut@@ Hébert, Paul C. @@aut@@ Asfar, Pierre @@aut@@ Lauzier, François @@aut@@ Seely, Andrew J.E. @@aut@@ Day, Andrew G. @@aut@@ Mehta, Sangeeta @@aut@@ Muscedere, John @@aut@@ Bagshaw, Sean M. @@aut@@ Ferguson, Niall D. @@aut@@ Cook, Deborah J. @@aut@@ Kanji, Salmaan @@aut@@ Turgeon, Alexis F. @@aut@@ Herridge, Margaret S. @@aut@@ Subramanian, Sanjay @@aut@@ Lacroix, Jacques @@aut@@ Adhikari, Neill K.J. @@aut@@ Scales, Damon C. @@aut@@ Fox-Robichaud, Alison @@aut@@ Skrobik, Yoanna @@aut@@ Whitlock, Richard P. @@aut@@ Green, Robert S. @@aut@@ Koo, Karen K.Y. @@aut@@ Tanguay, Teddie @@aut@@ Magder, Sheldon @@aut@@ Heyland, Daren K. @@aut@@ |
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Lamontagne, François |
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Lamontagne, François misc Vasopressors misc Shock misc Blood pressure targets misc Resuscitation Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial |
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Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial Vasopressors (dpeaa)DE-He213 Shock (dpeaa)DE-He213 Blood pressure targets (dpeaa)DE-He213 Resuscitation (dpeaa)DE-He213 |
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Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial |
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Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial |
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Lamontagne, François Meade, Maureen O. Hébert, Paul C. Asfar, Pierre Lauzier, François Seely, Andrew J.E. Day, Andrew G. Mehta, Sangeeta Muscedere, John Bagshaw, Sean M. Ferguson, Niall D. Cook, Deborah J. Kanji, Salmaan Turgeon, Alexis F. Herridge, Margaret S. Subramanian, Sanjay Lacroix, Jacques Adhikari, Neill K.J. Scales, Damon C. Fox-Robichaud, Alison Skrobik, Yoanna Whitlock, Richard P. Green, Robert S. Koo, Karen K.Y. Tanguay, Teddie Magder, Sheldon Heyland, Daren K. |
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Elektronische Aufsätze |
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Lamontagne, François |
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10.1007/s00134-016-4237-3 |
| title_sort |
higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial |
| title_auth |
Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial |
| abstract |
Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. © Springer-Verlag Berlin Heidelberg and ESICM 2016 |
| abstractGer |
Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. © Springer-Verlag Berlin Heidelberg and ESICM 2016 |
| abstract_unstemmed |
Purpose In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods We randomly assigned critically ill patients who were presumed to suffer from vasodilatory shock regardless of admission diagnosis to a lower (60–65 mmHg) versus a higher (75–80 mmHg) MAP target. The primary objective was to measure the separation in MAP between groups. We also recorded days with protocol deviations, enrolment rate, cardiac arrhythmias and mortality for prespecified subgroups. Results A total of 118 patients were enrolled from 11 centres (2.3 patients/site/month of screening). The between-group separation in MAP was 9 mmHg (95 % CI 7–11). In the lower and higher MAP groups, we observed deviations on 12 versus 8 % of all days on vasopressors (p = 0.059). Risks of cardiac arrhythmias (20 versus 36 %, p = 0.07) and hospital mortality (30 versus 33 %, p = 0.84) were not different between lower and higher MAP arms. Among patients aged 75 years or older, a lower MAP target was associated with reduced hospital mortality (13 versus 60 %, p = 0.03) but not in younger patients. Conclusions This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy. © Springer-Verlag Berlin Heidelberg and ESICM 2016 |
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Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial |
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https://dx.doi.org/10.1007/s00134-016-4237-3 |
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Meade, Maureen O. Hébert, Paul C. Asfar, Pierre Lauzier, François Seely, Andrew J.E. Day, Andrew G. Mehta, Sangeeta Muscedere, John Bagshaw, Sean M. Ferguson, Niall D. Cook, Deborah J. Kanji, Salmaan Turgeon, Alexis F. Herridge, Margaret S. Subramanian, Sanjay Lacroix, Jacques Adhikari, Neill K.J. Scales, Damon C. Fox-Robichaud, Alison Skrobik, Yoanna Whitlock, Richard P. Green, Robert S. Koo, Karen K.Y. Tanguay, Teddie Magder, Sheldon Heyland, Daren K. |
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Meade, Maureen O. Hébert, Paul C. Asfar, Pierre Lauzier, François Seely, Andrew J.E. Day, Andrew G. Mehta, Sangeeta Muscedere, John Bagshaw, Sean M. Ferguson, Niall D. Cook, Deborah J. Kanji, Salmaan Turgeon, Alexis F. Herridge, Margaret S. Subramanian, Sanjay Lacroix, Jacques Adhikari, Neill K.J. Scales, Damon C. Fox-Robichaud, Alison Skrobik, Yoanna Whitlock, Richard P. Green, Robert S. Koo, Karen K.Y. Tanguay, Teddie Magder, Sheldon Heyland, Daren K. |
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10.1007/s00134-016-4237-3 |
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2024-07-03T21:12:51.985Z |
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| score |
7.400257 |