Oct 2, 2026 · 15 min · 13 segments
Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from…
Preeti MalaniHostLinda BrubakerHost
Dr. Inwald and colleagues compared a permissive mean arterial pressure target, or MAP, greater than the fifth percentile for age with usual care in the pressure randomized clinical trial, which was conducted in 23 pediatric intensive care units across three countries.
The investigators enrolled 1,900 critically ill children receiving invasive ventilation and vasoactive medications for hypotension.
The permissive MAP goal was 50 to 55 millimeters of mercury for the four to nine year age range.
Although the permissive strategy lowered the total norepinephrine equivalent exposure by 37.5%, the primary outcome, a composite of death and duration of invasive ventilation at 30 days was not significantly different between the study groups.
The authors conclude that a lower MAP target reduced vasoactive exposure without a clear effect on the main clinical outcome.
In an accompanying editorial, Dr. Horvat and colleagues say that this trial offers reassurance that vasoactive infusions may often be weaned earlier as shock resolves in pediatric patients.
But they also caution that the separation in achieved blood pressure between study groups was modest.
a map of 58 millimeters of mercury in the permissive group compared with 61 millimeters of mercury in the usual care group.
So the study does not necessarily provide evidence that the fifth percentile map goal is the right target for every critically ill child.
Dr. Inwald and colleagues compared a permissive mean arterial pressure target, or MAP, greater than the fifth percentile for age with usual care in the pressure randomized clinical trial, which was conducted in 23 pediatric intensive care units across three countries.
The investigators enrolled 1,900 critically ill children receiving invasive ventilation and vasoactive medications for hypotension.
The permissive MAP goal was 50 to 55 millimeters of mercury for the four to nine year age range.
Although the permissive strategy lowered the total norepinephrine equivalent exposure by 37.5%, the primary outcome, a composite of death and duration of invasive ventilation at 30 days was not significantly different between the study groups.
The authors conclude that a lower MAP target reduced vasoactive exposure without a clear effect on the main clinical outcome.
In an accompanying editorial, Dr. Horvat and colleagues say that this trial offers reassurance that vasoactive infusions may often be weaned earlier as shock resolves in pediatric patients.
But they also caution that the separation in achieved blood pressure between study groups was modest.
a map of 58 millimeters of mercury in the permissive group compared with 61 millimeters of mercury in the usual care group.
So the study does not necessarily provide evidence that the fifth percentile map goal is the right target for every critically ill child.
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