MAP 65: A Goldilocks Story

EMRA*Cast host Matt Dillon puts MAP65 under a microscope with sepsis researcher/CCM expert Emily Brant and EMRA CritCare Vice Chair Dustin Slagle in this #EMRACritCare + #EMRAcast journal club collab. Find out what we’re learning about the studies influencing the Surviving Sepsis campaign and critical care medicine in America.

OVERVIEW

Targeting MAP 65 has become such a natural reflex for many of us that we often take it for granted. But if you ever stop to look where that number actually came from you might be surprised at how difficult it is to find an answer. Emily Brant and Dustin Slagle will take you on a journey through the literature on this topic from past to present. Lactates, pressors, end-organ-perfusion - all are fair game in this episode. We will be diving into some recent papers that try to hash out the true optimal blood pressure targets, and along the way you may pick up some tips and tricks when managing your shocky patients.

Take-Home Points

• The origins of MAP 65 come from many studies looking at signs of end-organ perfusion in both animal and human studies. Studies performed by Swan-Ganz helped pave the way for many of the targets of the Rivers Trial, ultimately leading to the guidelines in the Surviving Sepsis Campaign targeting a MAP of 65.
• SEPSISPAM was a trial comparing MAP targets of 65-70 and 80-85. Spoiler alert… no difference!
• MAP 65 trial looked at more conservative targets, specifically MAP 65-70 vs MAP 60-65. Once again… no difference!
• At the end of the day, tailor individualized therapy for individual patients. Ensure adequate source control and follow signs of end-organ-perfusion.

References

• Asfar P; SEPSISPAM Investigators. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370(17):1583-93.
• Lamontagne F, Richards-Bell A, Thomas K, et al. Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial. JAMA. 2020;323(10):938–949.
• EMRA Critical Care Committee Review of the Literature: Sepsis https://www.emra.org/search/?queryString=sepsis