6/30/23, 12:52 AM 65 trial Pathway Feedback Search Clinical Topics Home Studies 65 trial 65 trial Trial question What is the effect of reduced exposure to vasopressors through permissive hypotension in older critically ill patients with vasodilatory hypotension? Study design Multi-center Open label RCT Population Characteristics of study participants 50.0% female N = 2455 50.0% male 2455 patients (1239 female, 1216 male) Inclusion criteria: ICU patients aged 65 years or older with vasodilatory hypotension Key exclusion criteria: contraindications to permissive hypotension, vasopressors being used solely as therapy for bleeding, acute ventricular failure or post-cardiopulmonary bypass vasoplegia, ongoing treatment for brain injury or spinal cord injury, death perceived as imminent Interventions N=1283 permissive hypotension (reducing or discontinuing exposure to vasopressors guided by mean arterial pressure target of 60-65 mmHg) N=1300 usual care (receiving vasopressors at the discretion of treating clinicians) Primary outcome Death at 90 days 43.8 % 43.8 41 32.8 % 21.9 % 10.9 % No significant difference 0.0 % https://web.pathway.md/studies/recDmoYeW9Tpkfs0l 1/2 6/30/23, 12:52 AM 65 trial Pathway Permissive hypotension Usual care No significant difference in death at 90 days (41% vs. 43.8%; RR 0.93, 95% CI 0.85 to 1.03) Secondary outcomes No significant difference in death at ICU discharge (29.9% vs. 30.7%; RR 0.97, 95% CI 0.86 to 1.1) No significant difference in duration of renal support among all patients (1.4 days vs. 1.5 days; AD -0.1 days, 95% CI -0.4 to 0.2) No significant difference in duration of advanced respiratory support among all patients (4.5 days vs. 4.8 days; AD -0.3 days, 95% CI -1.1 to 0.4) Safety outcomes No significant differences in serious adverse events, including acute renal failure, supraventricular cardiac arrhythmia. Conclusion In ICU patients aged 65 years or older with vasodilatory hypotension, permissive hypotension was not superior to usual care with respect to death at 90 days. Reference Fran ois Lamontagne, Alvin Richards-Belle, Karen Thomas et al. Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial. JAMA. 2020 Feb 12;323(10):938-949. Open reference URL https://web.pathway.md/studies/recDmoYeW9Tpkfs0l 2/2