Blood Pressure Goals in Critically Ill Patients.

Blood pressure goals in the intensive care unit (ICU) have been extensively investigated in large datasets and have been associated with various harm thresholds at or greater than a mean pressure of 65 mm Hg. While it is difficult to perform interventional randomized trials of blood pressure in the ICU, important evidence does not support defense of a higher pressure, except in retrospective database analyses. Perfusion pressure may be a more important target than mean pressure, even more so in the vulnerable patient population. In the cardiac ICU, blood pressure targets are tailored to specific cardiac pathophysiology and patient characteristics. Generally, the goal is to maintain adequate blood pressure within a certain range to support cardiac function and to ensure end organ perfusion. Individualized targets demand the use of both invasive and noninvasive monitoring modalities and frequent titration of medications and/or mechanical circulatory support where necessary. In this review, we aim to identify appropriate blood pressure targets in the ICU, recognizing special patient populations and outlining the risk factors and predictors of end organ failure.

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Copyright: © 2023 The Author(s).

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D. Ashish K. Khanna is on the advisory board for Medtronic, Philips Research North America, and Retia Medical. He serves as a key opinion leader for Edwards Lifesciences, GE Healthcare, Potrero Medical, and Caretaker Medical. He is also funded with a Clinical and Translational Science Institute (CTSI) NIH/NCTAS KL2 TR001421 award for a trial on continuous postoperative hemodynamic and saturation monitoring and from the Hypertension and Vascular Research Center at the Wake Forest School of Medicine. He has previously received grant funding for the Angiotensin II in High Output Shock trial. The other authors have no competing interests to declare. The department of anesthesiology at Atrium Health Wake Forest is supported by Edwards Lifesciences under a master clinical trials agreement and has received funding from Medtronic, Masimo, Retia Medical, Potrero Medical, and Caretaker Medical.