In a 10-centre randomized trial, 172 adults undergoing elective cardiac surgery with bypass received MAP targets within ±10% of preoperative baseline through 24 hours postoperatively or standard targets ≥65 mm Hg. The 7-day composite of death, acute kidney injury, or prespecified neurologic complications occurred in 32% versus 29% (relative risk 1.1; 95% CI 0.7–1.8). The trial stopped early because of increased bleeding. Hemorrhagic complications occurred in 18% versus 3% (P=0.003). Individualized intraoperative target adherence was limited to 33% of time, despite greater vasopressor use.
This trial did not establish whether individualized MAP targeting reduces major postoperative complications. More bleeding was observed with individualized management, warranting attention in future studies.
Study limitation: Early termination and limited target adherence constrain interpretation; the wide confidence interval does not establish equivalence between strategies.
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