From the Guidelines
The recommended target Mean Arterial Pressure (MAP) is 65 mmHg, as it has been shown to have a lower risk of atrial fibrillation, lower doses of vasopressors, and similar mortality compared to higher MAP targets 1.
Key Points to Consider
- The Surviving Sepsis Campaign guidelines recommend an initial MAP target of 65 mmHg over higher MAP targets, based on moderate-quality evidence 1.
- Targeting a MAP of 85 mmHg resulted in a significantly higher risk of arrhythmias, but the subgroup of patients with previously diagnosed chronic hypertension had a reduced need for renal replacement therapy (RRT) at this higher MAP 1.
- A recent pilot trial suggested that, in the subgroup of patients older than 75 years, mortality was reduced when targeting a MAP of 60–65 versus 75–80 mmHg, although the quality of evidence was moderate due to imprecise estimates (wide confidence intervals) 1.
Clinical Implications
- The choice of MAP target should be individualized to the patient's condition, taking into account factors such as chronic hypertension, age, and comorbidities.
- Regular monitoring of MAP and adjustment of vasopressor doses as needed is crucial to minimize the risk of complications and optimize patient outcomes.
- The evidence from the provided studies 1 suggests that a MAP target of 65 mmHg is a reasonable starting point, but may need to be adjusted based on individual patient characteristics and response to treatment.
From the Research
Overview of Antibiotic Prescriptions
- The study 2 found that the most common antibiotics prescribed were azithromycin, amoxicillin-clavulanate, doxycycline, amoxicillin, fluoroquinolones, and trimethoprim-sulfamethoxazole.
- The most common indications for antibiotic prescriptions were acute respiratory tract infection, urinary tract infection, skin and soft tissue infection, and chronic obstructive pulmonary disease (COPD) exacerbation.
Inappropriate Antibiotic Prescriptions
- The study 2 found that 76% of reviewed prescriptions were inappropriate, with 49.7% of cases having no indication for an antibiotic, 12.3% having an antibiotic indicated but the prescribed agent being guideline discordant, and 14% having a guideline-concordant antibiotic given for a guideline-discordant duration.
- Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately.
Comparison of Antibiotics
- The study 3 compared azithromycin extended release and amoxicillin/clavulanate for the treatment of acute sinusitis, finding that more patients randomized to azithromycin extended release experienced symptom resolution at day 5.
- The study 4 found that amoxicillin-clavulanate, azithromycin, ciprofloxacin, amoxicillin, and cephalexin were associated with cases of drug-induced liver injury, with amoxicillin-clavulanate having the highest number of cases.
Treatment of Specific Infections
- The study 5 discussed the management of Pseudomonas aeruginosa infections, highlighting the limited choices of antibiotics and the emergent resistance of the pathogen.
- The study 6 reviewed the penetration of different antibiotics into bone and joint tissues, finding that most antibiotics showed good penetration, but few exceptions included penicillin and metronidazole.