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The following is a summary of “Individualized mean arterial pressure targets in critically ill patients guided by non-invasive cerebral-autoregulation: a scoping review,” published in the May 2025 issue of Critical Care by Xie et al. 

Current guidelines set a standard mean arterial pressure (MAP) target for resuscitation, but individual differences in cerebral autoregulation and cardiology factors suggested that personalized targets may better support cerebral perfusion and limit complications. 

Researchers conducted a retrospective study to summarize numerical values, feasibility, and clinical evidence on personalized MAP targets in individuals with critical illness using non-invasive monitoring methods.  

They followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines and conducted a systematic search of Ovid MedLine, Embase (Ovid), and the Cochrane Library (Wiley) on September 28, 2023, and 2 reviewers independently screened titles, abstracts, and full texts for eligibility. Reference lists were manually reviewed to identify additional relevant studies.  

The results showed that out of 7,738 studies identified, 49 met inclusion criteria, with 45 (92%) observational and 4 (8%) interventional. Patient groups included cardiac surgery (26, 53%), non-cardiac major surgery (4, 8%), cardiac arrest (8, 16%), brain injury (7, 14%), respiratory failure and shock (3, 6%), and sepsis (3, 6%). Optimal MAP was reported in 24 studies (49%), lower limit of autoregulation in 23 (47%), and upper limit in 10 (20%) and 34 studies noted partial data loss due to software errors, abnormal data, insufficient MAP variation, and workflow issues. Available randomized controlled trials (RCTs) revealed difficulties maintaining patients within personalized MAP targets. Associations were explored between personalized MAP targets and neurological and non-neurological outcomes, with the strongest links found for acute kidney injury and major morbidity and mortality and 10 studies assessed demographic predictors, identifying few predictors of personalized targets.  

Investigators concluded that a variability in personalized MAP targets, highlighting key gaps in observational data and RCTs that must be addressed to improve outcomes in population with critical illness. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05432-5