Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey

Paul J Young^{1

2

3

4}, Rinaldo Bellomo^{3

4

5

6

7}, Abdulrahman Al-Fares^{8

9}, David Gc Antognini¹⁰, Yaseen M Arabi¹¹, Muhammad Sheharyar Ashraf¹², Sean M Bagshaw¹³, Alastair J Brown^{3

4

6

14}, Sarah Buabbas¹⁵, Lewis Campbell¹⁶, Jonathan M Chen¹⁷, Ross C Freebairn¹⁸, Tomoko Fujii^{3

19}, Mohd Shahnaz Hasan²⁰, Aditi Jain²¹, Nai An Lai²², Sanjay Lakhey²³, Matthew Mac Partlin²⁴, Sam Marment²⁵, James P A McCullough^{26

27}, Alistair D Nichol²⁸, Mahesh Ramanan^{29

30

31

32}, Ashim Regmi³³, Manoj Saxena³⁴, Ian Seppelt³⁵, Nozomu Shima³⁶, Pawel Twardowski³⁷, Kyle C White^{38

39}, François Lamontagne^{40

41}

Affiliations

¹ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
² Medical Research Institute of New Zealand, Wellington, New Zealand.
³ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
⁵ Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁶ Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
⁷ Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Victoria, Australia.
⁸ Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait.
⁹ Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait.
¹⁰ Department of Intensive Care, Monash Health - Victorian Heart Hospital / Monash Medical Centre, Melbourne, Australia.
¹¹ College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National-Guard Health Affairs, Riyadh, Saudi Arabia.
¹² Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan.
¹³ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.
¹⁴ Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia.
¹⁵ Department of Anaesthesia, Critical Care Medicine and Pain Medicine, Jaber Alahmad Alsabah Hospital, Kuwait.
¹⁶ Charles Darwin University and Royal Darwin Hospital, Darwin, Northern Territory, Australia.
¹⁷ Intensive Care Unit, Tauranga Hospital, Te Whatu Ora Hauora a Toi Bay of Plenty, Tauranga, New Zealand.
¹⁸ Intensive Care Unit, Hawke's Bay Hospital, Hastings, New Zealand.
¹⁹ Department of Intensive Care, Jikei University Hospital, Tokyo, Japan.
²⁰ Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
²¹ Medicover Hospital, Mumbai, India.
²² Intensive Care Services, Mater Health, Queensland, Australia.
²³ Department of Critical Care, B & B Hospital, Kathmandu, Nepal.
²⁴ Wollongong Hospital, New South Wales, Australia.
²⁵ Sunshine Coast University Hospital, Queensland, Australia.
²⁶ Intensive Care Unit, Gold Coast University Hospital, Queensland, Australia.
²⁷ Griffith University, Gold Coast, Queensland, Australia.
²⁸ University College Dublin Clinical Research Centre and St Vincents University Hospital, Dublin, Ireland.
²⁹ Caboolture Hospital, Metro North Hospital and Health Services, Brisbane, Queensland, Australia.
³⁰ Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
³¹ Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, Queensland, Australia.
³² The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
³³ Al Zahra Hospital, Dubai, United Arab Emirates.
³⁴ St George Hospital Clinical School and The Critical Care Program, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
³⁵ Nepean Clinical School, University of Sydney, New South Wales, Australia.
³⁶ Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan.
³⁷ Southern Critical Care, Dunedin Public Hospital, Dunedin, New Zealand.
³⁸ Princess Alexandra Hospital, Woolloongabba, Australia.
³⁹ Queensland University of Technology, Brisbane, Australia.
⁴⁰ Université de Sherbrooke, Quebec, Canada.
⁴¹ Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada.

PMID: 40109286
PMCID: PMC11919583
DOI: 10.1016/j.ccrj.2024.12.001

Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey

Paul J Young et al. Crit Care Resusc. 2025.

. 2025 Feb 27;27(1):100095.

doi: 10.1016/j.ccrj.2024.12.001. eCollection 2025 Mar.

Authors

Affiliations

¹ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
² Medical Research Institute of New Zealand, Wellington, New Zealand.
³ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
⁵ Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁶ Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
⁷ Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Victoria, Australia.
⁸ Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait.
⁹ Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait.
¹⁰ Department of Intensive Care, Monash Health - Victorian Heart Hospital / Monash Medical Centre, Melbourne, Australia.
¹¹ College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National-Guard Health Affairs, Riyadh, Saudi Arabia.
¹² Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan.
¹³ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.
¹⁴ Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia.
¹⁵ Department of Anaesthesia, Critical Care Medicine and Pain Medicine, Jaber Alahmad Alsabah Hospital, Kuwait.
¹⁶ Charles Darwin University and Royal Darwin Hospital, Darwin, Northern Territory, Australia.
¹⁷ Intensive Care Unit, Tauranga Hospital, Te Whatu Ora Hauora a Toi Bay of Plenty, Tauranga, New Zealand.
¹⁸ Intensive Care Unit, Hawke's Bay Hospital, Hastings, New Zealand.
¹⁹ Department of Intensive Care, Jikei University Hospital, Tokyo, Japan.
²⁰ Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
²¹ Medicover Hospital, Mumbai, India.
²² Intensive Care Services, Mater Health, Queensland, Australia.
²³ Department of Critical Care, B & B Hospital, Kathmandu, Nepal.
²⁴ Wollongong Hospital, New South Wales, Australia.
²⁵ Sunshine Coast University Hospital, Queensland, Australia.
²⁶ Intensive Care Unit, Gold Coast University Hospital, Queensland, Australia.
²⁷ Griffith University, Gold Coast, Queensland, Australia.
²⁸ University College Dublin Clinical Research Centre and St Vincents University Hospital, Dublin, Ireland.
²⁹ Caboolture Hospital, Metro North Hospital and Health Services, Brisbane, Queensland, Australia.
³⁰ Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
³¹ Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, Queensland, Australia.
³² The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
³³ Al Zahra Hospital, Dubai, United Arab Emirates.
³⁴ St George Hospital Clinical School and The Critical Care Program, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
³⁵ Nepean Clinical School, University of Sydney, New South Wales, Australia.
³⁶ Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan.
³⁷ Southern Critical Care, Dunedin Public Hospital, Dunedin, New Zealand.
³⁸ Princess Alexandra Hospital, Woolloongabba, Australia.
³⁹ Queensland University of Technology, Brisbane, Australia.
⁴⁰ Université de Sherbrooke, Quebec, Canada.
⁴¹ Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada.

PMID: 40109286
PMCID: PMC11919583
DOI: 10.1016/j.ccrj.2024.12.001

Abstract

Objective: This study aimed to evaluate intensive care doctors' views about a large-scale pragmatic minimum mean arterial pressure (MAP) targets trial and their attitudes and beliefs about minimum MAP targets in different clinical scenarios.

Design: An online survey was conducted.

Setting and participants: An online survey was distributed to intensive care doctors in sites participating in a large-scale international randomised clinical trial evaluating oxygen therapy targets in 15 countries and to additional intensive care clinicians from Canada.

Main outcome measures: Outcomes included the expressed level of support for a large pragmatic trial to evaluate minimum MAP targets in critically ill adults and stated current practice and acceptability of minimum MAP for specific scenarios.

Results: The response rate to our survey for respondents who work in sites participating in the mega randomised registry trial research program was 265 out of 701 (37.8%), with an additional 56 out of 256 (21.8%) responses obtained from a direct email containing a link to the survey sent to intensive care clinicians in Canada. A total of 309 of 321 respondents (96.3%) were supportive, in principle, of conducting a very large pragmatic trial to evaluate MAP targets in intensive care unit patients receiving noradrenaline. The commonest response in all scenarios was to agree that the optimal minimum MAP target was uncertain. In all scenarios, except for active bleeding, the most common reported minimum MAP target was 65 mmHg; for patients who were actively bleeding, the most common reported target was 60 mmHg.

Conclusions: Our data suggest that intensive care clinicians are broadly supportive of a large-scale pragmatic minimum MAP targets in intensive care unit patients receiving noradrenaline.

Keywords: Blood pressure targets; Clinical trials; Intensive care; Mean arterial pressure; Survey.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Paul Young reports financial support was provided by Health Research Council of New Zealand. Nai An Lai reports a relationship with Edwards Lifesciences Corporation that includes funding grants. Mahesh Ramanan reports a relationship with Metro North Hospital and Health Services that includes funding grants. Francois Lamontagne has patent pending to the University of Sherbrooke. Rinaldo Bellomo and Paul Young declare that they are members of the Editorial Board for Critical Care and Resuscitation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Figure 1**
Potential design for a large-scale minimum mean arterial pressure targets trial. ICU, intensive care unit; MAP, mean arterial pressure.

**Figure 2**
Extent to which respondents agreed that the optimal minimum MAP target is uncertain for specific scenarios in adults in the ICU receiving a noradrenaline infusion. ICU, intensive care unit; MAP, mean arterial pressure.

**Figure 3**
Reported acceptability of minimum mean arterial pressure targets in specific scenarios in a randomised clinical trial. MAP, mean arterial pressure.

**Figure 4**
Reported acceptability of minimum mean arterial pressure targets by age category and surgery type in a randomised clinical trial. MAP, mean arterial pressure.

See this image and copyright information in PMC

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Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey

Affiliations

Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources