Imperial College London
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Professor Anthony Gordon

Faculty of Medicine, Department of Surgery & Cancer

Chair in Anaesthesia and Critical Care
 
 
 
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Contact

 

anthony.gordon

 
 
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Location

 

ICUQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Lamontagne:2020:10.1001/jama.2020.0930,
author = {Lamontagne, F and Richards-Belle, A and Thomas, K and Harrison, DA and Sadique, MZ and Grieve, RD and Camsooksai, J and Darnell, R and Gordon, AC and Henry, D and Hudson, N and Mason, AJ and Saull, M and Whitman, C and Young, JD and Rowan, KM and Mouncey, PR},
doi = {10.1001/jama.2020.0930},
journal = {JAMA},
pages = {938--949},
title = {Effect of reduced exposure to vasopressors on 90-day mortality in older critically ill patients with vasodilatory hypotension},
url = {http://dx.doi.org/10.1001/jama.2020.0930},
volume = {323},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Importance  Vasopressors are commonly administered to intensive care unit (ICU) patients to raise blood pressure. Balancing risks and benefits of vasopressors is a challenge, particularly in older patients.Objective  To determine whether reducing exposure to vasopressors through permissive hypotension (mean arterial pressure [MAP] target, 60-65 mm Hg) reduces mortality at 90 days in ICU patients aged 65 years or older with vasodilatory hypotension.Design, Setting, and Participants  A multicenter, pragmatic, randomized clinical trial was conducted in 65 ICUs in the United Kingdom and included 2600 randomized patients aged 65 years or older with vasodilatory hypotension (assessed by treating clinician). The study was conducted from July 2017 to March 2019, and follow-up was completed in August 2019.Interventions  Patients were randomized 1:1 to vasopressors guided either by MAP target (60-65 mm Hg, permissive hypotension) (n = 1291) or according to usual care (at the discretion of treating clinicians) (n = 1307).Main Outcome and Measures  The primary clinical outcome was all-cause mortality at 90 days.Results  Of 2600 randomized patients, after removal of those who declined or had withdrawn consent, 2463 (95%) were included in the analysis of the primary outcome (mean [SD] age 75 years [7 years]; 1387 [57%] men). Patients randomized to the permissive hypotension group had lower exposure to vasopressors compared with those in the usual care group (median duration 33 hours vs 38 hours; difference in medians, –5.0; 95% CI, –7.8 to –2.2 hours; total dose in norepinephrine equivalents median, 17.7 mg vs 26.4 mg; difference in medians, –8.7 mg; 95% CI, –12.8 to −4.6 mg). At 90 days, 500 of 1221 (41.0%) in the permissive hypotension compared with 544 of 1242 (43.8%) in the usual care group had died (absolute risk difference, −2.85%; 95% CI, −6.75 to 1.05; P = .15) (unadjusted relative r
AU  - Lamontagne,F
AU  - Richards-Belle,A
AU  - Thomas,K
AU  - Harrison,DA
AU  - Sadique,MZ
AU  - Grieve,RD
AU  - Camsooksai,J
AU  - Darnell,R
AU  - Gordon,AC
AU  - Henry,D
AU  - Hudson,N
AU  - Mason,AJ
AU  - Saull,M
AU  - Whitman,C
AU  - Young,JD
AU  - Rowan,KM
AU  - Mouncey,PR
DO  - 10.1001/jama.2020.0930
EP  - 949
PY  - 2020///
SN  - 0098-7484
SP  - 938
TI  - Effect of reduced exposure to vasopressors on 90-day mortality in older critically ill patients with vasodilatory hypotension
T2  - JAMA
UR  - http://dx.doi.org/10.1001/jama.2020.0930
UR  - https://jamanetwork.com/journals/jama/fullarticle/2761427
VL  - 323
ER  -
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