Individualised Blood Pressure Targets Versus Standard Care Among Critically Ill Patients With Shock

Inclusion criteria

• 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:

• Lactate level greater than or equal to 2 mmol/l or base deficit greater than or equal to 3 mmol/l,
• Urine output less than or equal to 0.5 ml/kg/h or <40 ml/h for 2 or more consecutive hours
• Respiratory rate >22 per minute
• Altered mentation (Glasgow Coma Score <14)

Exclusion criteria

• 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)

• Cerebral perfusion pressure guided therapy e.g. intracranial hemorrhage or subarachnoid hemorrhage or traumatic brain injury
• Abdominal perfusion pressure guided therapy
• Aortic injury (e.g. dissection or post-operative)
• Post cardiac surgery
• Any other condition requiring higher or lower BP target specifically