Individualized mean arterial pressure during cardiac surgery The OPTIPAM Randomized Clinical Trial
In brief
Individualized blood pressure targets raised bleeding after cardiac surgery, with no clear benefit
In a trial stopped early after 172 patients, targeting blood pressure near each patient's preoperative level did not reduce the combined risk of death, kidney injury or neurologic complications: these occurred in 32% versus 29% with standard care. Bleeding complications were more common with individualized targets, 18% versus 3%, but the small, prematurely stopped trial cannot establish whether the strategy affects major complications.
- Journal
- Anesthesiology (Q1)
- Published
- 6 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Richard Descamps, Paul-Michel Mertes, Martin Charvin, Olivier Desebbe, Hélène Charbonneau, Jean-Luc Fellahi, et al.
- PMID
- 42993977
- DOI
- 10.1097/ALN.0000000000006471
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 8 November 2026): Randomized trial of intraoperative blood-pressure targets in cardiac surgery
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.