High-normal versus low-normal mean arterial pressure thresholds in critically ill patients: A systematic review and meta-analysis of randomized trials
Bibliographic record
Abstract
Abstract Targeted blood pressure thresholds remain unclear in critically ill patients. Two prior systematic reviews have not demonstrated differences in mortality with a high mean arterial pressure (MAP) threshold but they only included patients with septic shock. Thus, we conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the effect of a high-normal versus low-normal MAP on mortality in all pertinent disease states for critically ill patients. We searched six databases from inception until September 5th 2021 for RCTs of critically ill patients targeted to either a high-normal (≥ 65 mm Hg) versus a low-normal (≥ 60 mm Hg) MAP threshold for at least 24-hours. We assessed study quality using the RoB-2 tool and the risk ratio (RR) was used as the summary measure of association. We included 7 RCTs with 3772 patients. Three trials were conducted in patients following out-of-hospital cardiac arrest, two in distributive shock, one in septic shock, and one in hepatorenal syndrome. The pooled RR for mortality was 1.06 (95%CI 0.98 to 1.17). There was no significant between-study heterogeneity (I2 = 0%, 95%CI: 0 to 47%). Furthermore, there was no difference in the rates of favourable neurologic outcome or renal replacement therapy between the high-normal versus low-normal MAP groups. This systematic review and meta-analysis demonstrates that there is no difference in mortality amongst critically ill patients targeted to a high-normal versus low-normal MAP target.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.051 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.033 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".