Closed-loop versus manual vasopressor titration for blood pressure control in surgical and critically ill…

Meta-analysisJournal of clinical anesthesia· Jun 2026

Closed-loop versus manual vasopressor titration for blood pressure control in surgical and critically ill patients: A systematic review and meta-analysis of randomised trials.

Katie Chiou, Philip Patrick, Ishita Srivastava … Sean Coeckelenbergh

Perioperative MedicineMeta-analysisTreatmentQ1IF 3.9

Closed-loop vasopressor systems cut time with blood pressure below target versus manual titration

Closed-loop versus manual vasopressor titration for blood pressure control in surgical and critically ill patients: A systematic review and meta-analysis of randomised trials.

Katie Chiou … Sean Coeckelenbergh

Journal of clinical anesthesia · Jun 2026 · Q1 in Anesthesiology

Background

Perioperative hypotension is associated with myocardial injury, acute kidney injury, and mortality, yet manual vasopressor titration frequently results in suboptimal blood pressure (blood pressure) control.

Methods

We conducted a PRISMA-guided systematic review and meta-analysis on PubMed, CENTRAL, EMBASE, and Web of Science from inception to June 2025.

n = 640 patients

Results

closed-loop control cut time spent below the blood pressure target

MD -15.81 (95% CI -20.38 to -11.25)

CI excludes the null - significant

More results

The length of post-anaesthesia care unit-intensive care unit stay (MD = -0.05 min, 95% CI = -1.10 to 1.00 min; p = 0.93; I 2 = 0%; n = 198) did not differ between the two groups.

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Conclusion · 1 of 2

In surgical and critically-ill patients, closed-loop systems were associated with improved adherence to predefined blood pressure targets with reduced time below target and increased time in target compared to manual vasopressor titration.

Conclusion · 2 of 2

Whether these haemodynamic improvements translate into beneficial impact on patient outcomes will require confirmation in large multicentre randomised trials. SYSTEMATIC REVIEW

Closed-loop versus manual vasopressor titration for blood pressure control in surgical and critically ill patients: A systematic review and meta-analysis of randomised trials.

Closed-loop versus manual vasopressor titration for blood pressure control in surgical and critically ill patients: A systematic review and meta-analysis of randomised trials.

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