Permissive Blood Pressure Targets in Pediatric Critical Care: The PRESSURE Randomized Clinical Trial.
David P Inwald, Emma Laing, Julia M Broomhall et al.
✦ AI-curated · Sources linked
In 30 seconds
The multicenter, unblinded pragmatic randomized PRESSURE trial compared a permissive mean arterial pressure (MAP) target (greater than the fifth percentile for age) with usual physician-set targets in hypotensive, invasively ventilated children receiving vasoactive drugs in 23 PICUs across 3 countries. Among 1900 randomized patients, the permissive strategy reduced median norepinephrine-equivalent total dose by 37.5%, but did not significantly improve the 30-day composite of mortality and duration of invasive ventilation (probabilistic index, 0.52 [95% CI, 0.49-0.54]; P = .23). Most secondary outcomes were also similar between groups.
Key findings
- The permissive MAP strategy reduced median norepinephrine-equivalent total dose by 37.5% compared with usual care.
- The primary 30-day outcome did not differ significantly between groups: probabilistic index, 0.52 [95% CI, 0.49-0.54]; P = .23.
- Among survivors, median PICU stay was shorter with permissive targets: 159 [79-286] vs 166 [92-319] hours; probabilistic index, 0.53 [95% CI, 0.50-0.56].
- Kidney replacement therapy receipt and adverse events did not differ between groups.
Why it matters
This trial addresses whether accepting lower MAP targets can reduce vasoactive exposure without worsening major outcomes in critically ill children. The lower drug dose did not translate into a significant improvement in the primary outcome, while most secondary outcomes were similar. These findings help clarify the trade-off between blood pressure targets and vasoactive treatment in this population.
What to keep in mind
The trial was unblinded, and the primary outcome analysis included 1814 of the 1900 randomized patients.