RCEM Learning December 2025
Dec 10, 2025
Discussion of a trial testing higher mean arterial pressure targets in older patients with septic shock. A year-end roundup of major 2025 guidelines including resuscitation, sepsis, obesity and ambulance/urgent care plans. Debate on routine prophylactic antibiotics for non-operative facial fractures based on a multicenter study. Highlights of new online CPD articles on normalization of deviance, child mental health, and rest and recovery.
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Higher MAP Targets May Harm Older Septic Patients
- OPTPRESS found higher MAP targets (80–85 mmHg) in elderly septic shock patients were associated with higher 90-day mortality compared with standard targets (65–70 mmHg).
- Trial stopped early for harm after ~200 patients showing ~10% absolute higher mortality in the high-target group, suggesting pressors or higher MAP may cause net harm.
MAP Is A Blunt Surrogate For Perfusion
- The physiologic rationale for 65 mmHg MAP is blunt and not individualized; higher targets may increase vasopressor exposure without improving microcirculatory or mitochondrial function.
- Trials measuring MAP assume macrocirculation surrogate equals organ perfusion, which may miss true cellular outcomes.
Stick To MAP 65 As ED Default
- Aim for a MAP around 60–70 mmHg in ED sepsis resuscitation as the pragmatic baseline target.
- Reserve attempts at higher targets for ICU review only when individualized monitoring or clear indication justifies vasopressor escalation.