The main effect of vasopressors is arteriolar vasoconstriction, and therefore excessive use of vasopressors increases MAP without correspondingly increasing microcirculatory (and therefore organ) blood flow. In addition, organs have autoregulatory mechanisms and can tolerate lower MAP levels without compromising blood flow.
We propose a perfusion-centered strategy focused on reversing organ hypoperfusion without a predefined MAP target. With this approach, interventions are centered on increasing cardiac output primarily by fluid administration while dynamically assessing fluid responsiveness and using vasopressors to prevent life-threatening reductions in vital organ perfusion, using safe MAP target levels likely to be lower than 65 mmHg.1-4