From the Guidelines
A mean arterial pressure (MAP) of greater than 65 mmHg is considered adequate for perfusion in most critically ill patients. This recommendation is based on the Surviving Sepsis Campaign guidelines, which suggest that targeting a MAP of 65 mmHg is sufficient for organ perfusion, while also minimizing the risk of adverse effects such as arrhythmias 1. The guidelines are supported by several studies, including a multicenter trial that found no significant difference in mortality between patients targeted to a MAP of 65 mmHg versus 85 mmHg 1.
Some key points to consider when targeting a MAP of 65 mmHg include:
- Initial management with adequate fluid resuscitation using crystalloids, typically 30 ml/kg
- Use of norepinephrine as the first-line vasopressor, starting at 0.05-0.1 mcg/kg/min and titrating as needed
- Addition of vasopressin as a second agent, if necessary, at a dose of 0.03 units/min
- Individualization of MAP goals based on patient-specific factors, such as age, comorbidities, and clinical response
It's also important to note that some patients, such as those with chronic hypertension, may require a higher MAP target of 75-85 mmHg for adequate organ perfusion 1. However, this should be determined on a case-by-case basis, taking into account the patient's individual needs and response to treatment. Overall, targeting a MAP of 65 mmHg is a reasonable and evidence-based approach for most critically ill patients, as supported by the guidelines and available research 1.
From the Research
Mean Arterial Pressure (MAP) and Perfusion
- A MAP of >65 mmHg is generally considered sufficient for perfusion in critically ill patients, including those with septic shock 2, 3.
- However, some studies suggest that a higher MAP goal of >70 mmHg may be beneficial in certain patients, such as those with chronic hypertension 3.
- A meta-analysis of randomized controlled trials found that a high MAP goal (>70 mmHg) was associated with similar outcomes to a standard MAP goal (60-70 mmHg) in critically ill patients, including mortality, duration of mechanical ventilation, and ICU length of stay 4.
Septic Shock and MAP
- In patients with septic shock, a MAP target of at least 65 mmHg is recommended, with higher values considered in cases of chronic hypertension 2.
- Norepinephrine is commonly used as a vasopressor in septic shock, and its effectiveness and safety have been demonstrated in several studies 5, 6.
- A systematic review and meta-analysis found that norepinephrine was associated with a reduced incidence of arrhythmia compared to other vasopressors in septic shock patients 6.