Would you treat hypotension with a mean arterial pressure (MAP) of 70?

From the Guidelines

I would not immediately treat a mean arterial pressure (MAP) of 70 mmHg unless there are signs of end-organ hypoperfusion or the patient is symptomatic, as this is generally considered the threshold for adequate organ perfusion 1. When managing a patient with a MAP of 70 mmHg, it is essential to assess for symptoms such as dizziness, altered mental status, decreased urine output, or other signs of inadequate perfusion. The patient's baseline blood pressure should also be considered, as a MAP of 70 mmHg might be normal for someone who typically runs low. Some key points to consider in the management of hypotension include:

• Assessing the patient for signs of end-organ hypoperfusion or symptoms
• Considering the patient's baseline blood pressure
• Initial treatment options, if necessary, include intravenous fluids like normal saline or lactated Ringer's solution to increase intravascular volume
• If fluid resuscitation is insufficient, vasopressors such as norepinephrine might be considered, but this would typically occur in a monitored setting 1
• The underlying cause of hypotension should always be identified and addressed, as treating the number alone without understanding the etiology could mask important clinical information or lead to inappropriate management. According to the Surviving Sepsis Campaign guidelines, the initial goal for hemodynamic support in patients with sepsis is to restore a mean arterial pressure of 65 to 70 mmHg 1. Therefore, a MAP of 70 mmHg is within the acceptable range, and treatment should be focused on addressing the underlying cause of hypotension and managing symptoms, rather than solely targeting the blood pressure number.

From the FDA Drug Label

To provide hemodynamic support in septic shock associated hypotension in adult patients, the suggested dosing infusion rate of intravenously administered epinephrine is 0.05 mcg/kg/min to 2 mcg/kg/min, and is titrated to achieve a desired mean arterial pressure (MAP). The answer is yes, epinephrine can be used to treat hypotension with a mean arterial pressure (MAP) of 70, as the dosage is titrated to achieve a desired MAP 2.

• The dosage may be adjusted periodically to achieve the desired blood pressure goal.
• Titration of epinephrine is crucial to achieve the desired MAP.
• The goal is to achieve a desired mean arterial pressure (MAP).

From the Research

Hypotension Treatment

• The provided studies do not directly address the treatment of hypotension with a mean arterial pressure (MAP) of 70 3, 4, 5, 6, 7.
• However, study 3 discusses the importance of blood pressure regulation in patients undergoing microsurgical free tissue transfer and mentions the use of intravenous fluid administration and vasoactive pharmacological support with vasopressors to address perioperative hypotension.
• Studies 6 and 7 compare the effects of normal saline and lactated Ringer's solution on resuscitation of uncontrolled hemorrhagic shock, but do not provide specific guidance on treating hypotension with a MAP of 70.

Resuscitation Fluids

• Lactated Ringer's solution is superior to normal saline for the resuscitation of uncontrolled hemorrhagic shock in swine, as it requires less volume and is associated with less hyperchloremic acidosis and dilutional coagulopathy 6.
• Resuscitation with lactated Ringer's solution results in an elevation of the lactate level that is not associated with acidosis, whereas normal saline resuscitation is associated with hyperchloremic acidosis and dilutional coagulopathy 6, 7.

Blood Pressure Management

• Study 5 provides evidence-based guidelines for the management of high blood pressure in adults, but does not address the specific issue of treating hypotension with a MAP of 70.
• The study recommends treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg 5.