Thread by @VTA_Symposium

First talk of the day - Dr Hilary Klonin, a paediatric intensivist from Hull University Teaching Hospital Trust - on 'Less is more, except when it isn't'. Talking about paediatric BP targets in critical care. #VTA23

Up to 50% of paediatric ICU survivors suffer from some sort of impairment. Could this be because the BP targets in paediatric ICU are unclear and too high a target is used? #VTA23

In 2008, a review at their hospital challenged the BP target of the 50th centile for age, and wanted to compare it to a permissive BP target. This was to be done only in critically ill patients, but started from the ED or ward, until critical illness resolved. #VTA23

They compared the usual care (high BP target) to the permissive (low BP target), and found that in about 400 patients:
- The risk of mortality was similar pre-admission
- The usual care group had higher survival without new neurological morbidity
#VTA23

So the lower permissive targets were associated with higher rates of neurological morbidity! This is in contrast to many other paradigm shifts to lower targets in adult medicine (e.g. Hb targets, MAP targets) over the past decade!
#VTA23

This may be due to altered cerebral autoregulation in children compared to adults. This is based on other date in anaesthetised children, which showed a lower limit of cerebral autoregulatory MAP, with the limit closer to baseline MAP. #VTA23

Really fascinating study looking at how we are still trying to find the 'sweet spot' with basics such as BPs, and how the science moves back and forth, hopefully closer to the truth! #critcare #VTA23 #FOAMcc