Individualized mean arterial pressure during cardiac surgery The OPTIPAM Randomized Clinical Trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: Whether targeting an individualized mean arterial pressure (MAP) during cardiac surgery improves outcomes remains uncertain. The balance between improved perfusion and vasopressor-driven blood pressure augmentation is unclear. METHODS: In this single-blind, multicenter randomized clinical trial conducted in 10 tertiary centers in France, adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were assigned to either individualized MAP management (target within ±10% of preoperative baseline during surgery and for 24 h postoperatively) or standard management (target MAP ≥65 mm Hg). The primary outcome was a composite of all-cause death, acute kidney injury, or prespecified neurologic complications within 7 days. Safety outcomes included hemorrhagic complications and transfusion requirements. RESULTS: A total of 172 patients were enrolled before the trial was stopped early by the data and safety monitoring board because of increased bleeding in the individualized group. Mean intraoperative MAP was higher with individualized management (80.6 vs 75.6 mm Hg; P<0.001), despite limited target adherence (33% of intraoperative time) and greater vasopressor use. The primary outcome occurred in 27 of 85 patients (32%) in the individualized group and 25 of 87 (29%) in the standard group (relative risk, 1.1; 95% CI, 0.7 to 1.8; P=0.76). Hemorrhagic complications occurred more frequently in the individualized group (18% vs 3%; P=0.003). CONCLUSIONS: In patients undergoing cardiac surgery, it was not possible to determine whether an individualized MAP strategy reduced major postoperative complications. More bleeding complications were observed in the individualized group. Future studies should further investigate this safety signal when evaluating individualized blood pressure targets.
Source: Anesthesiology
Authors: Richard Descamps, Paul-Michel MERTES, Martin CHARVIN, Olivier DESEBBE, Hélène CHARBONNEAU, Jean-Luc FELLAHI, Laure CAZENAVE, François LABASTE, Diane LENA, Bertrand ROZEC, Geraldine DESSERTAINE, Stéphane DEBROCZI, William GREUB, Thomas LESTHIEVENT, Anne-Claude ROCHE, Clémence TOMADESSO, Laure PEYRO-SAINT-PAUL, Jean-Jacques PARIENTI, Anais R. BRIANT, Marc-Olivier FISCHER, for the OPTIPAM investigators
Institutions: Centre Hospitalier Universitaire de Caen Normandie, Hôpitaux Universitaires de Strasbourg, Hôpital Civil, Strasbourg, Centre Hospitalier Universitaire de Clermont-Ferrand, Clinique Pasteur, Hospices Civils de Lyon, Hôpital Louis Pradel, Centre National de la Recherche Scientifique, Université Toulouse III - Paul Sabatier, Inserm, Centre Hospitalier Universitaire de Toulouse, RESTORE, Université de Toulouse, Institut Arnault Tzanck, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Université de Nantes, Nantes Université, Université Grenoble Alpes
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7225393849