What are our options for Paediatric Trauma Pain relief?

The OPTPRESS Trial

The Efficacy of targetting high MAP for older patients with Septic Shock

Should we be targeting a higher MAP in that subset of patients with sepsis who progress to shock? Mortality is high in the elderly and even higher in the very old.

What They Did

This was a multicentre, pragmatic, open-label, randomised controlled trial at 29 Japanese centres, randomising patients >65 years old with septic shock.

Patients were randomised to a higher blood pressure group (MAP = 80-85 mmHg) or a control group (65-70 mm Hg). The target MAP was maintained for 72 hours or until pressors were no longer needed. 

If a noradrenaline dose of at least 0.1mcg/kg/min was required to maintain the MAP, Vasopressin was commenced and could be increased to 0.04 U/min. 

Primary Outcome: All cause mortality at 90 days.

What They Found.....

Outcomes

Targeting a higher MAP of 80–85 mmHg significantly increased mortality compared with targeting a MAP of 65–70 mmHg.

The EVERDAC Trial

Do we need arterial lines in shock?

Is managing shock without early arterial catheterization, noninferior to early catheter insertion with regard to death from any cause at 28 days?

What They Did

This was an open-label, investigator-initiated, pragmatic, multicenter, parallel-group, noninferiority, randomized, controlled trial, conducted in 9 ICUs  in France. n=1010

What They Found

With respect to mortality by day 28, delaying arterial catheterisation and using NIBP was non-inferior to arterial catheterisation. This avoided arterial catheterisation in 85% of patients.

My Take on This

This is an unblinded trial and found that non-invasive blood pressure monitoring was not inferior to invasive blood pressure monitoring in shock. If we look a little more closely we see the following that this study predominantly looked at septic shock.........

Will this paper change our practice? Should it?