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. 2025 Mar 13;27(1):100103.
doi: 10.1016/j.ccrj.2025.100103. eCollection 2025 Mar.

Mean arterial pressure in critically ill adults receiving vasopressors: A multicentre, observational study

Kyle C White  1   2   3   4 , Lachlan Quick  1   5 , Zachary Durkin  5 , James McCullough  6   7 , Kevin B Laupland  3   8 , Sebastiaan Blank  9 , Antony G Attokaran  4   10 , Aashish Kumar  11 , Kiran Shekar  4   12 , Peter Garrett  6   13 , Jason Meyer  1 , Alexis Tabah  3   4   14 , Mahesh Ramanan  3   4   8   15 , Stephen Luke  16   17 , Anis Chaba  18   19   20 , Rinaldo Bellomo  18   19   21   22 , François Lamontagne  23   24 , Paul J Young  19   21   25   26 ; Queensland Critical Care Research Network (QCCRN)
Collaborators, Affiliations

Mean arterial pressure in critically ill adults receiving vasopressors: A multicentre, observational study

Kyle C White et al. Crit Care Resusc. .

Abstract

Objective: Mean arterial pressure (MAP) management is a key aspect of treatment in critically ill patients receiving vasopressor therapy. Guidelines in different clinical subgroups have proposed various target MAP values. This study aimed to describe delivered MAP values and corresponding vasopressor doses in such patients.

Design: Multicenter, retrospective cohort study of adult intensive care unit (ICU) admissions.

Setting: 12 ICUs in Queensland, Australia, from January 1, 2015, to December 31, 2021.

Participants: Patients receiving vasopressors for at least six continuous hours in the ICU. We studied the delivered MAP values using hourly data based on averaging all validated values obtained from the ICU monitors and average hourly doses of vasopressors.

Main outcome measure: The primary outcome was the mean MAP during the entire cohort's first 72 hours of ICU admission, whilst vasopressors were administered.

Results: In 26,519 patients who received vasopressors for at least six continuous hours, the median age was 62 years, and 9,373 (35%) were admitted after elective surgery. The median time from ICU admission to vasopressor commencement was 2 hours, and the median duration of vasopressor therapy was 27 hours. At 72 hours, 6,627 (25.0%) patients remained on vasopressors. The mean hourly MAP was 72 mmHg in the first six hours, then steadily increased to ≈75 mmHg at 72 hours. In the first 72 hours, 11,032 (41.6%) patients had a mean MAP of 70-74 mmHg, and 5,914 (22.3%) had a mean MAP of 75-79 mmHg. For every clinical subgroup, a MAP of 70-74 mmHg was the most common mean MAP, and the proportion of patients with a mean MAP of 60-65mmHg was less than 5%.

Conclusions: In a large, multicenter study of heterogeneous critically ill patients on vasopressors, the mean hourly MAP was > 70 mmHg. This mean hourly MAP was observed consistently over diverse clinical subgroups and is higher than recommended by guidelines.

Keywords: Critical care; Hypotension; Mean arterial pressure; Norepinephrine; Vasopressin; Vasopressors.

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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: R Bellomo and P Young are both members of the Critical Care and Resuscitation editorial board. Dr Kyle White.

Figures

Fig. 1
Fig. 1
Mean arterial pressure in patients receiving vasopressors.
Fig. 2
Fig. 2
Proportion of patients by MAP. Mean arterial pressure (MAP) values were obtained from the hourly average of MAP values and were categorised into one decimal place (example 74.3).
Fig. 3
Fig. 3
Mean MAP during first 72 h of ICU admission. Mean arterial pressure (MAP) values were obtained from the hourly average of MAP values and were categorised to one decimal place (example 74.3).
Fig. 4
Fig. 4
Proportion of patients by MAP value bands according to clinical subgroups. Mean arterial pressure (MAP) values obtained from hourly average of MAP values and were categorised to one decimal place (example 74.3). AKI = acute kidney injury; AMI = acute myocardial infarction; CTS = cardiothoracic surgery; HTN = chronic hypertension.
See this image and copyright information in PMC

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