The Pulse - December 2024

In this monthly edition, we examine 3 practice-changing studies from December 2024.

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1. MAP It Out: Are Lower MAP Targets Just as Safe?  

   We’ve all been there: you’re patient is on norepinephrine in the ICU and you’re trying to titrate it down or stop it but that pesky MAP is just below 65. The patient seems to be clinically stable but that MAP... yep, there’s the ICU RN paging you about it.  While this study is unlikely to change guideline recommendations (currently for MAP >65), it does provide some backup if you decide to allow for MAP of 60. This meta-analysis examined patient outcomes between high-MAP (70-85) and low-MAP (60-70) target groups. The lower-MAP target group had a nonsignificant decrease in 90-day all-cause mortality. Of note, the study could not exclude that lower MAP target causes harm overall. Angriman F et al. NEJM Evid 2024 Nov 18.  

   Study Type: meta analysis of 3 RCTs conducted in UK, France, and Canada, examining 3352 patients among 103 hospitals; 76% with sepsis   

   Link: https://doi.org/10.1056/EVIDoa2400359 

2. Sobering Truth: The Key to Staying Dry  

   If you’re anything like me, discharging the patient with alcohol use disorder on their Nth admission for withdrawal feels somewhat nihilistic. This retrospective study found that discharge to residential treatment programs had the biggest impact on the post-hospitalization trajectory with fewer readmissions and higher rates of sobriety. Bonus points for making it to primary care appointments, which also cut readmissions significantly. Despite the finding of other trials, discharging with prescription for AUD meds did not decrease re-admission rates. Allaudeen N et al. J Hosp Med 2024 Dec.  

   Study Type: retrospective, multicenter (19) study at VA hospitals of 594 patients admitted for alcohol withdrawal  

   Link: https://doi.org/10.1002/jhm.13458