Renal resistive index-guided mean arterial pressure titration in sepsis: a prospective single-center, single-blind, parallel-group randomized controlled trial

In sepsis, optimizing mean arterial pressure (MAP) for organ perfusion remains challenging. We conduct a single-center, single-blind, parallel-group randomized controlled trial enrolling 274 sepsis patients to evaluate whether renal resistive index (RRI)-guided MAP titration (MAP titration group, MTG) reduces 28-day all-cause mortality (primary endpoint) compared with conventional treatment (conventional treatment group, CTG). Post-titration, RRI decreases significantly in the MTG versus CTG (0.61 vs. 0.67, P < 0.001). However, 28-day mortality does not differ (25/138 vs. 36/136; RR 0.69, 95% CI 0.44-1.08; P = 0.11). These findings suggest that RRI-guided MAP titration improves renal hemodynamics but does not reduce mortality in this single-center trial; multicenter confirmation is warranted. (Chinese Clinical Trial Registry, ChiCTR2200057136, registered 1 March 2022; https://www.chictr.org.cn/showprojEN.html?proj=153154).