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An open label pragmatic study in 29 Japanese hospitals randomized septic shock patients over age 65 to either a high (MAP 80-85) or control (65-70) group. They then looked at all cause 90 day mortality. The study was stopped early due to a significantly higher percentage of mortality in the higher MAP group.
The study isn’t blinded and is only done in one country, however it does raise the question of what is the ideal MAP for older septic shock patients.
References
Endo A, Yamakawa K, Tagami T, Umemura Y, Wada T, Yamamoto R, Nagasawa H, Takayama W, Yagi M, Takahashi K, Kojima M, Narita C, Kazuma S, Takahashi J, Shiraishi A, Todani M, Nakane M, Nagata T, Tanaka S, Yokokawa Y, Takahashi K, Ishikita H, Hisamune R, Sasaki J, Muramatsu KI, Sonobe H, Minami K, Hoshi H, Otomo Y; OPTPRESS trial investigators. Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial. Intensive Care Med. 2025 May;51(5):883-892. doi: 10.1007/s00134-025-07910-4. Epub 2025 May 13. PMID: 40358717; PMCID: PMC12130109.