• Robert Darnell, Alanna Brown, Emma Laing, Julia Edwards, David A Harrison, Joseph C Manning, Mark J Peters, Padmanabhan Ramnarayan, Samiran Ray, Zia Sadique, Barnaby R Scholefield, Dermot Shortt, Lamprini Lampro, Carly Au, Kathy M Rowan, Paul Mouncey, David P Inwald, and Protocolised Evaluation of Permissive Blood Pressure Targets Versus Usual Care (PRESSURE) Trial Investigators on behalf of the U.K. Paediatric Critical Care Society Study Group (PCCS-SG).
• Clinical Trials Unit, Intensive Care National Audit and Research Centre (ICNARC), London, United Kingdom.
• Pediatr Crit Care Me. 2024 Apr 17.

ObjectivesManagement of hypotension is a fundamental part of pediatric critical care, with cardiovascular support in the form of fluids or vasoactive drugs offered to every hypotensive child. However, optimal blood pressure (BP) targets are unknown. The PRotocolised Evaluation of PermiSSive BP Targets Versus Usual CaRE (PRESSURE) trial aims to evaluate the clinical and cost-effectiveness of a permissive mean arterial pressure (MAP) target of greater than a fifth centile for age compared with usual care.DesignPragmatic, open, multicenter, parallel-group randomized control trial (RCT) with integrated economic evaluation.SettingEighteen PICUs across the United Kingdom.PatientsInfants and children older than 37 weeks corrected gestational age to 16 years accepted to a participating PICU, on mechanical ventilation and receiving vasoactive drugs for hypotension.InterventionsAdjustment of hemodynamic support to achieve a permissive MAP target greater than fifth centile for age during invasive mechanical ventilation.Measurements And Main ResultsRandomization is 1:1 to a permissive MAP target or usual care, stratified by site and age group. Due to the emergency nature of the treatment, approaching patients for written informed consent will be deferred until after randomization. The primary clinical outcome is a composite of death and days of ventilatory support at 30 days. Baseline demographics and clinical status will be recorded as well as daily measures of BP and organ support, and discharge outcomes. This RCT received Health Research Authority approval (reference 289545), and a favorable ethical opinion from the East of England-Cambridge South Research Ethics Committee on May 10, 2021 (reference number 21/EE/0084). The trial is registered and has an International Standard RCT Number (reference 20609635).ConclusionsTrial findings will be disseminated in U.K. national and international conferences and in peer-reviewed journals.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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