The SEPSISPAM trial: Mean arterial pressure targets in septic shock [Classics Series]

This study summary is an excerpt from the book 2 Minute Medicine’s The Classics in Medicine: Summaries of the Landmark Trials

1. This trial demonstrated that mortality did not differ with a mean arterial pressure (MAP) target of 80-85mmHg (36.6%) as compared to 65-70mmHg (34.0%) in septic shock patients.

2. Incidence of new atrial fibrillation was significantly increased in the 80-85mmHg MAP threshold group.

Original Date of Publication: April 2014

Study Rundown: The Sepsis and Mean Arterial Pressure (SEPSISPAM) trial compared a resuscitation target MAP of 80-85mmHg to a target of 65-70mmHg in septic shock patients. The primary end point measured was all-cause mortality measured at 28 days after resuscitation, which did not differ significantly between groups. Secondary outcomes of 90-day mortality and serious adverse events also did not differ between groups. Although, new onset atrial fibrillation and need for renal-replacement in chronic hypertension patients was increased in the 80-85mmHg target group. The limitations of the present study included variations in MAP during treatment as well as differential use of glucocorticoids between patients. Although, MAP fluctuation was not significant enough to warrant a protocol violation. The SEPSISPAM trial was the first to demonstrate that low versus high MAP targets in septic shock patients do not impact mortality following resuscitation.

Click to read the study in NEJM

In-Depth [randomized control trial]: The SEPISPAM trial included patients who required resuscitation for septic shock, randomizing participants into a target MAP of 80-85 mmHg (n = 142) as compared to 65-70 mmHg (n = 132). The primary outcome of all-cause mortality at 28 days did not differ in the high target group as compared to the low target group (HR 1.07; 95%CI 0.84-1.38), which was sustained at 90 days (HR 1.04; 95%CI 0.83-1.30). Conversely, the high threshold groups had significantly higher rates of new atrial fibrillation (p = 0.02) and need for renal-replacement therapy in participants with chronic hypertension (p = 0.04). Serious adverse events did not differ between groups (p = 0.64).

Asfar P, Meziani F, Hamel J-F, Grelon F, Megarbane B, Anguel N, et al. High versus Low Blood-Pressure Target in Patients with Septic Shock. New England Journal of Medicine. 2014 Apr 24;370(17):1583–93.

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