Individualised Blood Pressure Targets versus Standard Care among Critically Ill patients with Shock - A Multicentre Randomised Controlled Trial comparing mortality outcomes.

Hunter New England Local Health District0 个研究点目标入组 1,260 人开始时间: 2023年1月16日最近更新: 2023年3月20日

适应症

试验速览

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•ICU patients aged greater than or equal to 40 years
•The patient is deemed to be in shock, defined as clinician-initiated vasopressor/inotropic therapy AND supported by any of the following within the last 24 hours:
•o Lactate level greater than or equal to 2 mmol/l or base deficit greater than or equal to 3 mmol/l,
•o Urine output less than or equal to 0.5 ml/kg/h or <40 ml/h for 2 or more consecutive hours
•o Respiratory rate >22 per minute
•o Altered mentation (Glasgow Coma Score <14)

•Patients who are moribund, or have documented not-for-resuscitation orders
•At least 24 hours have lapsed from the time of initiation of vasopressor or inotropic support
•Patients who are either receiving or are deemed to imminently need renal replacement therapy.
•Patients who already have an increase in serum creatinine of >350 µmol/l from baseline.
•End stage renal disease
•Patients where trauma is the main reason for the current ICU admission.
•Previously enrolled in the REACT Shock RCT
•Pregnancy, if known
•Active bleeding (clinical suspicion or >2 packed red blood cells within last 24 hours)
•Insufficient (less than two) pre-illness BP readings are available.
•Patients on extracorporeal support (such as extracorporeal membrane oxygenation, intra-aortic balloon pump, or ventricular assist device).
•Potential contraindications to either higher or lower BP targets (including but not limited to)
•o Cerebral perfusion pressure guided therapy e.g. intracranial hemorrhage or subarachnoid hemorrhage or traumatic brain injury
•o Abdominal perfusion pressure guided therapy
•o Aortic injury (e.g. dissection or post-operative)
•o Post cardiac surgery
•o Any other condition requiring higher or lower BP target specifically

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