Optimal Blood Pressure at Vasopressor Weaning in Intensive Care Units — What Are Targets of Blood Pressure Management?

Objective: Vasopressors are one of the main treatments for severe hypotension or shock, which commonly occurs in intensive care unit (ICU) patients. However, only a few studies have been conducted on the appropriate targets for vasopressor weaning. This study aims to explore the effect of blood pressure at vasopressor weaning on the probability of in-hospital mortality. Design: Single-center retrospective observational study. Setting: ICU from Beth Israel Deaconess Medical Center between 2008 and 2019.PatientsICU patients who received vasopressor treatment were selected. Patients younger than 18 years old, died before vasopressor weaning or without blood pressure measurement at weaning were excluded. Finally, 8,298 patients were included. Result: General additive model (GAM) result showed that blood pressures at weaning had “U-shape” non-linear relationship with in-hospital mortality probability. The optimal values ​​of WSBP, WDBP, and WMAP are approximately 120, 65, and 80 mmHg, respectively. Compared with the lower blood pressure cohort, the sensitivity analysis results showed that when WSBP, WDBP, and WMAP are within 120-160, 50-65, >80 mmHg, the hospital mortality risk were lowest with HR(95%CI)= 0.37(0.32,0.43), 0.45(0.39,0.52) and 0.32(0.28,0.38), respectively. The results of the subgroup analysis explicated that the blood pressure booster weaning had an interaction with congestive heart failure, cerebrovascular disease, chronic pulmonary disease, diabetes, and renal disease. GAM results revealed that there were differences in the optimal weaning blood pressure of patients with different diagnoses. Conclusion: Higher vasopressor weaning blood pressure(WSBP>95, WDBP>50, WMAP>65 mmHg) can significantly improve survival, and the best target WSBP, WDBP, WMAP is 120-160, 50-65, and >80 mmHg. When treating patients with different diagnoses, the optimal blood pressure may shift, requiring comprehensive analysis in treatment strategy decision-making. Funding Statement: None to declare. Declaration of Interests: None to declare. Ethics Approval Statement: The study was an analysis of a third-party anonymized publicly available database with pre-existing institutional review board (IRB) approval.