?? Paper of the day
Prashant Nasa
ICU Physician - Co-editor: Rational use of IV Fluids in Critically ill (link in bio)- PROVE Network - Delphi Methodology - Fluid and Oxygen are Drugs - X: @drnasap
??Editorial in JAMA: Blood Pressure Management After Endovascular Therapy
?? Summary:
The article discusses the results of two recent randomized clinical trials (RCTs) that aimed to determine the optimal blood pressure (BP) target for patients after endovascular therapy for acute ischemic stroke. The article highlights that previous RCTs also showed similar results. The article proposes selective intervention based on projected BP trajectories and excludes high-risk patients for hypotension from future trials. The author also emphasizes the need to consider patients' physiology and intervene with BP control only when severe hypertension is expected to increase the risk of intracerebral haemorrhage.
?? Takeaways:
1??Two recent RCTs (OPTIMAL BP and BEST) failed to show benefit with intensive BP control or maybe harm after endovascular therapy for acute ischemic stroke.
2?? Previous RCTs (BP-TARGET and ENCHANTED2/MT) also failed to demonstrate improved outcomes with intensive BP lowering.
3?? The association between lower BP and better outcomes in retrospective analyses may be confounded, and finding a universal BP target for all patients is unlikely.
?? Personalisation is the key to BP management after endovascular thrombectomy. Intensive BP management increases the risk of hypotension (SBP <100 mm Hg), which may cause harm.