6/10
📉The Absolute Risk Reduction indicates 10 fewer deaths per 1000 patients , which translates to an Number Needed to Treat of 100.

⚰️For every 100 patients where we choose lower blood pressure targets (defined as the minimum tolerated level), we prevent one death.

5/10
🎯Our Bayesian meta-analysis shows a 97.4% probability that higher blood pressure targets could increase mortality.

💔This means there's a very high likelihood that aiming for higher BP might be more harmful than beneficial.

It’s on my reading list. #LessIsMore can be beneficial in many ways.

NephroCheck results may be influenced by urine output and hemodilution

Do we need different thresholds in different populations?

Our experience now published on Journal of Cardiothoracic and Vascular Anesthesia

San Raffaele Anesthesia and Intensive Care
Fabrizio Monaco, MD paulemann Rosa Labanca Stefano Fresilli Rinaldo Bellomo

We're looking for centers in South and Central America to enrol 50 patients in the STARGATEstudy

If you are interested visit stargatestudy.com or contact Vincenzo Russotto

Orlando R. Pérez-Nieto
Otavio Ranzani
ECMO Heart Team Mx
Fernando Zampieri
Dra Ludhmila Hajjar
SACH
sopemi…

1/9 ❗️❗️❗️ Critical Care Medicine just published a meta-analysis of RCTs on critically-ill and perioperative blood pressure (BP) targets! What is more beneficial for survival: targeting Higher or Lower BP? 🧵🧵🧵journals.lww.com/ccmjournal/abs…

6/6 To learn about the outcomes of 28 RCTs (12 in critically ill and 16 in perioperative settings) involving 15,672 patients, stay tuned to our meta-analysis updates.

Our upcoming posts will shed light on vital BP management insights.

3/10
🦣Our meta-analysis is the largest ever on blood pressure management in critically ill and perioperative setting

- 28 RCTs

-15,672 patients

It's the first to include both critically ill and perioperative populations, evaluating each group separately.

2/10
⚠️Important clarification:
In our meta-analysis, patients were not treated specifically to achieve lower BP targets.

Our findings do not advocate for inducing hypotension, but rather for reevaluating existing blood pressure understanding and management strategies.

Do we have more guidance on blood pressure targets in the ICU and perioperative settings? What do low or high targets mean? Excellent work Filippo D'Amico Giovanni Landoni, MD and team! Stay tuned for more! Critical Care Medicine

Philippe Rola Good point!

Not all hypotension are the same

Flow=MAP-CVP/R

MAP=CO x R + CVP

Increasing MAP through resistance could reduce flow

1/6🧐 Observational studies have long noted that hypotension is linked to adverse events in perioperative and critical patients, influencing clinical practice and guidelines.

🔗 But is this a true cause-effect relationship, or just bias due to confounding?

🔀 Let’s see what the…

4/10
💥Lower BP targets led to reduced mortality compared to higher targets

13.3% vs 14.4%

RR 0.93, 95% CI, 0.87–0.99

p=0.03

This suggests a significant benefit of lower targets.

Low Versus High Blood Pressure Targets in Critically Ill... : Critical Care Medicine journals.lww.com/ccmjournal/abs… Congrats Giovanni Landoni, MD and the group. #Lessismore #Lower #Better SFAR Anesthésie Réanimation SFAR Jeunes

9/10
🌟 Positive Secondary Outcomes!
Patients with lower BP targets experienced fewer complications:

🫀Lower rate of atrial fibrillation 3.1% vs 4.0% (OR 0.7, p=0.003)

🩸less frequently required transfusion 16.5% vs 20.5% (OR 0.71, p=0.03).

❓Which is the correct BP target in critically ill❓
❌ Probably NOT the most appropriate question‼️
✅ Is blood flow adequate to ensure organ perfusion?
⚠️Interventions to reach a 'comfort zone' BP may lead to higher mortality
#protectivehemodynamics

🔗journals.lww.com/ccmjournal/abs…

1/2
🌟 Highlights: Critically ill patients experiencing even more pronounced benefits with lower BP targets 36.7% vs. 39.7%; RR 0.93, p=.04

🔍 In our study, TSA indicated that the required sample size was achieved in critically ill patients. What does this mean?…

1/10
🚨Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients

📊Our meta-analysis will redefine how blood pressure is considered in anesthesia and critical care.

This study marks a 'before' and 'after' in our understanding of BP.

Key findings follow

🚀 Just published!

Our new meta-analysis revolutionizes blood pressure management in critical and perioperative patients.

Discover how our findings can change clinical practice. 🔗 journals.lww.com/ccmjournal/abs…

⚡ Breaking new ground in blood pressure management!

🫀 How should we manage blood pressure in critical care and perioperative settings?

📈 Check out our latest meta-analysis, which could redefine how we manage blood pressure in #criticalcare and #perioperative …