A randomised-controlled trial (TARGET-C) of high vs. low target mean arterial pressure in patients with cirrhosis and septic shock

Abstract

A target mean arterial pressure (MAP) of 65-70 mmHg has been suggested for patients with septic shock undergoing resuscitation, except for patients with chronic hypertension.1,2 In these patients, a higher target of 80-85 mmHg is a reasonable approximation that preserves the perfusion of kidneys.3 A high target strategy is associated with a higher risk of arrhythmias. Maintaining an appropriate organ perfusion pressure during sepsis is the ultimate goal of haemodynamic management.1,2 The surviving sepsis campaign recommends initial resuscitation with crystalloids at 30 ml/kg followed by the institution of vasoactive agents. Norepinephrine is usually considered the first-choice vasopressor to target a MAP of 65-70 mmHg.1 Despite this, the appropriate blood pressure target in patients with septic shock is controversial.