Critical IllnessREACT-SHOCKNCT05850962
Individualised Blood Pressure Targets Versus Standard Care Among Critically Ill Patients With Shock
A study testing Individualised MAP target in people with Critical Illness and Shock, run by Rakshit Panwar at 1 site in Australia.
Trial summary
Aim The aim of the proposed RCT is to determine effectiveness of a strategy, where MAP (mean arterial blood pressure) targets during vasopressor therapy for shock in ICU are individualized based on patients' own pre-illness MAP that would be derived as an average of up to five most recent pre-illness blood pressure… Read more about this study
- Who is it for?
- Ages 40 years and older
- Conditions the study is for
- Critical Illness, Shock
- What is being tested?
- Individualised MAP target
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 1,260 participants
- Where
- 1 siteAustralia
- Study dates
- 20 Jul 2023to 30 Oct 2029
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 40 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- ICU patients aged greater than or equal to 40 years
- The patient is deemed to be in shock, defined as clinician-initiated vasopressor/inotropic therapy AND supported by any of the following within the last 24 hours:
- Lactate level greater than or equal to 2 mmol/l or base deficit greater than or equal to 3 mmol/l,
- Urine output less than or equal to 0.5 ml/kg/h or <40 ml/h for 2 or more consecutive hours
- Respiratory rate >22 per minute
- Altered mentation (Glasgow Coma Score <14)
Who cannot join
- Patients who are moribund, or have documented not-for-resuscitation orders
- At least 24 hours have lapsed from the time of initiation of vasopressor or inotropic support
- Patients who are either receiving or are deemed to imminently need renal replacement therapy.
- Patients who already have an increase in serum creatinine of >350 µmol/l from baseline.
- End stage renal disease
- Patients where trauma is the main reason for the current ICU admission.
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- Previously enrolled in the REACT Shock RCT
- Pregnancy, if known
- Active bleeding (clinical suspicion or >2 packed red blood cells within last 24 hours)
- Insufficient (less than two) pre-illness BP readings are available.
- Patients on extracorporeal support (such as extracorporeal membrane oxygenation, intra-aortic balloon pump, or ventricular assist device).
- Potential contraindications to either higher or lower BP targets (including but not limited to)
- Cerebral perfusion pressure guided therapy e.g. intracranial hemorrhage or subarachnoid hemorrhage or traumatic brain injury
- Abdominal perfusion pressure guided therapy
- Aortic injury (e.g. dissection or post-operative)
- Post cardiac surgery
- Any other condition requiring higher or lower BP target specifically
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Flonda Probert contact
Australia1 site, 1 recruiting
- Recruiting
Hunter Medical Research Institute
Newcastle, New South Wales
Flonda Probert, 61240420951, flonda.probert@hmri.org.au
Naomi Knoblauch, 61240420951, naomi.knoblauch@hmri.org.au
About this study
Official title: Individualised Blood Pressure Targets Versus Standard Care Among Critically Ill Patients With Shock - A Multicentre Randomised Controlled Trial
Aim The aim of the proposed RCT is to determine effectiveness of a strategy, where MAP (mean arterial blood pressure) targets during vasopressor therapy for shock in ICU are individualized based on patients' own pre-illness MAP that would be derived as an average of up to five most recent pre-illness blood pressure readings.
Hypothesis We hypothesize that targeting a patient's pre-illness MAP during management of shock can minimize the degree of MAP-deficit (a measure of relative hypotension), which may help reduce the risk of 14-day mortality and major adverse kidney events by day 14 in ICU.
Read more
Endpoints The primary endpoint will be the all-cause mortality rate at day 14. Secondary endpoints will be the time to death through day 14 and day 90, major adverse kidney events (MAKE-14), renal replacement therapy (RRT) free days until day 28, and 90-day all-cause mortality.
Significance To date no major RCT has tested this strategy among ICU patients with shock. This pivotal trial will provide evidence to fulfil a crucial knowledge gap regarding a common and a fundamental intervention in critical care.
- Conditions
- Critical Illness, Shock
- Being tested
- Individualised MAP target
- Keywords
- Relative hypotension
- Medical subject headings
- Critical Illness, Shock
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Individualised MAP targetOther
The project will test an intervention that initially targets a patient's own pre-illness mean arterial pressure (MAP) during vasopressor support in ICU. The pre-illness MAP will be estimated from the most recent pre-illness BP readings recorded in medical records.
| Study group | Role | What they receive |
|---|---|---|
| Standard MAP target | No intervention | The comparator or the control group will be comprised of patients assigned to standard care, where vasopressor support will be titrated to maintain a default MAP of 65 mmHg, unless the treating clinician considers a different MAP target as more appropriate. |
| Individualised MAP target | Active comparator | In the intervention arm, a patient's own pre-illness mean arterial pressure (MAP) would be targeted (range: 55-95 mmHg) during vasopressor support in ICU. The pre-illness MAP will be estimated from most recent pre-illness BP readings following a standardized method (Panwar et al,. Blood Press. 2017:1-9) and will be targeted for the duration of vasopressor therapy for up to a maximum of five days. The treating clinician can tailor these BP targets as deemed suitable for current clinical state. The type of vasopressor that will be used is at the discretion of the treating clinician.
Study intervention will cease if a patient is considered well enough by the treating clinician for discharge out of ICU. If a patient is transported out of ICU for procedural intervention, then standard (non-study) treatment should be provided. Receives: Other: Individualised MAP target |
What is being measured
The primary outcome is the main question the study is designed to answer.
Mortality
All deaths from randomisation to 14 days
Measured: 14 days
Secondary outcomes (6)
Time to death through day 14
Measured: First 14 days of randomisation
Major Adverse Kidney Events
Defined as a composite of death, new renal replacement therapy, or final serum creatinine level >= 200% of the latest preillness creatinine level, as assessed from patient medical records.
Measured: 14 days from randomisation
Renal replacement therapy free days until day 28
Measured: 28 days from randomisation
Peak increase in serum creatinine levels
Measured: 28 days from randomisation
Time to death through day 90
Measured: First 90 days of randomisation
Mortality
All deaths from randomisation to 90 days
Measured: 90 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 May 2023
- Study start20 Jul 2023
- Primary completion30 Jan 2029 (estimated)
- Study completion30 Oct 2029 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (6)Papers the sponsor has linked to this study.
- Other trials for Critical IllnessStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 1,260 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Rakshit Panwar
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Rakshit Panwar, University of Newcastle, Australia
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05850962
- Sponsor's protocol ID
- G2200761
- Other IDs
- ACTRN12623000044628
- Acronym
- REACT-SHOCK
- Status last verified
- Oct 2026
- First submitted
- 29 Apr 2023
- Last updated
- 26 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Panwar R. Untreated Relative Hypotension Measured as Perfusion Pressure Deficit During Management of Shock and New-Onset Acute Kidney Injury-A Literature Review. Shock. 2018 May;49(5):497-507. doi: 10.1097/SHK.0000000000001033.
PubMed 29040214Panwar R, Tarvade S, Lanyon N, Saxena M, Bush D, Hardie M, Attia J, Bellomo R, Van Haren F; REACT Shock Study Investigators and Research Coordinators. Relative Hypotension and Adverse Kidney-related Outcomes among Critically Ill Patients with Shock. A Multicenter, Prospective Cohort Study. Am J Respir Crit Care Med. 2020 Nov 15;202(10):1407-1418. doi: 10.1164/rccm.201912-2316OC.
PubMed 32614244Panwar R, Van Haren F, Cazzola F, Nourse M, Brinkerhoff G, Quail A. Standard care versus individualized blood pressure targets among critically ill patients with shock: A multicenter feasibility and preliminary efficacy study. J Crit Care. 2022 Aug;70:154052. doi: 10.1016/j.jcrc.2022.154052. Epub 2022 May 5.
PubMed 35525132Panwar R, Lanyon N, Davies AR, Bailey M, Pilcher D, Bellomo R. Mean perfusion pressure deficit during the initial management of shock--an observational cohort study. J Crit Care. 2013 Oct;28(5):816-24. doi: 10.1016/j.jcrc.2013.05.009. Epub 2013 Jul 10.
PubMed 23849541Panwar R, Sullohern B, Shiel E, Alexis Brown C, Quail A. Validity of a protocol to estimate patients' pre-morbid basal blood pressure. Blood Press. 2018 Feb;27(1):10-18. doi: 10.1080/08037051.2017.1358055. Epub 2017 Jul 26.
PubMed 28745077Panwar R, Gibberd A, Oldmeadow C, Tiruvoipati R, Aneman A, Kansal A; REACT SHOCK investigators. REACT SHOCK trial protocol and analysis plan-a multicenter randomised controlled trial comparing individualised blood pressure target versus standard blood pressure target among critically ill patients with shock. Trials. 2025 Oct 14;26(1):409. doi: 10.1186/s13063-025-09142-9.
PubMed 41088147
Study at a glance
From the registry record, last updated by the sponsor on 26 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Individualised Blood Pressure Targets Versus Standard Care Among Critically Ill Patients With Shock - A Multicentre Randomised Controlled Trial
- ClinicalTrials.gov ID
- NCT05850962
- Acronym / sponsor ID
- REACT-SHOCK / G2200761
- Conditions
- Critical Illness, Shock
- Keywords
- Relative hypotension
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 1,260 participants (estimated)
- Lead sponsor
- Rakshit PanwarUniversity, hospital or other
- Study start
- 20 Jul 2023 (actual)
- Primary completion
- 30 Jan 2029 (estimated)
- Study completion
- 30 Oct 2029 (estimated)
- First posted
- 9 May 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Aim The aim of the proposed RCT is to determine effectiveness of a strategy, where MAP (mean arterial blood pressure) targets during vasopressor therapy for shock in ICU are individualized based on patients' own pre-illness MAP that would be derived as an average of up to five most recent pre-illness blood pressure readings.
Hypothesis We hypothesize that targeting a patient's pre-illness MAP during management of shock can minimize the degree of MAP-deficit (a measure of relative hypotension), which may help reduce the risk of 14-day mortality and major adverse kidney events by day 14 in ICU.
Endpoints The primary endpoint will be the all-cause mortality rate at day 14. Secondary endpoints will be the time to death through day 14 and day 90, major adverse kidney events (MAKE-14), renal replacement therapy (RRT) free days until day 28, and 90-day all-cause mortality.
Significance To date no major RCT has tested this strategy among ICU patients with shock. This pivotal trial will provide evidence to fulfil a crucial knowledge gap regarding a common and a fundamental intervention in critical care.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Standard MAP target | No intervention | –The comparator or the control group will be comprised of patients assigned to standard care, where vasopressor support will be titrated to maintain a default MAP of 65 mmHg, unless the treating clinician considers a different MAP target as more appropriate. |
| Individualised MAP target | Active comparator | Other: Individualised MAP targetIn the intervention arm, a patient's own pre-illness mean arterial pressure (MAP) would be targeted (range: 55-95 mmHg) during vasopressor support in ICU. The pre-illness MAP will be estimated from most recent pre-illness BP readings following a standardized method (Panwar et al,. Blood Press. 2017:1-9) and will be targeted for the duration of vasopressor therapy for up to a maximum of five days. The treating clinician can tailor these BP targets as deemed suitable for current clinical state. The type of vasopressor that will be used is at the discretion of the treating clinician. Study intervention will cease if a patient is considered well enough by the treating clinician for discharge out of ICU. If a patient is transported out of ICU for procedural intervention, then standard (non-study) treatment should be provided. |
Who may qualify
- Ages
- 40 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- ICU patients aged greater than or equal to 40 years
- The patient is deemed to be in shock, defined as clinician-initiated vasopressor/inotropic therapy AND supported by any of the following within the last 24 hours:
Key exclusion criteria (17 listed)
- Patients who are moribund, or have documented not-for-resuscitation orders
- At least 24 hours have lapsed from the time of initiation of vasopressor or inotropic support
- Patients who are either receiving or are deemed to imminently need renal replacement therapy.
- Patients who already have an increase in serum creatinine of >350 µmol/l from baseline.
- End stage renal disease
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Individualised MAP targetThe project will test an intervention that initially targets a patient's own pre-illness mean arterial pressure (MAP) during vasopressor support in ICU. The pre-illness MAP will be estimated from the most recent pre-illness BP readings recorded in medical records. | Other | Individualised MAP target |
Primary outcome
Mortality
Time frame: 14 days
All deaths from randomisation to 14 days
6 secondary outcomes
Time to death through day 14
Time frame: First 14 days of randomisation
Major Adverse Kidney Events
Time frame: 14 days from randomisation
Renal replacement therapy free days until day 28
Time frame: 28 days from randomisation
Peak increase in serum creatinine levels
Time frame: 28 days from randomisation
Time to death through day 90
Time frame: First 90 days of randomisation
Mortality
Time frame: 90 days
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 26 Oct 2026.
- Background: PubMed 29040214Panwar R. Untreated Relative Hypotension Measured as Perfusion Pressure Deficit During Management of Shock and New-Onset Acute Kidney Injury-A Literature Review. Shock. 2018 May;49(5):497-507. doi: 10.1097/SHK.0000000000001033.
- Results publication: PubMed 32614244Panwar R, Tarvade S, Lanyon N, Saxena M, Bush D, Hardie M, Attia J, Bellomo R, Van Haren F; REACT Shock Study Investigators and Research Coordinators. Relative Hypotension and Adverse Kidney-related Outcomes among Critically Ill Patients with Shock. A Multicenter, Prospective Cohort Study. Am J Respir Crit Care Med. 2020 Nov 15;202(10):1407-1418. doi: 10.1164/rccm.201912-2316OC.
- Results publication: PubMed 35525132Panwar R, Van Haren F, Cazzola F, Nourse M, Brinkerhoff G, Quail A. Standard care versus individualized blood pressure targets among critically ill patients with shock: A multicenter feasibility and preliminary efficacy study. J Crit Care. 2022 Aug;70:154052. doi: 10.1016/j.jcrc.2022.154052. Epub 2022 May 5.
- Results publication: PubMed 23849541Panwar R, Lanyon N, Davies AR, Bailey M, Pilcher D, Bellomo R. Mean perfusion pressure deficit during the initial management of shock--an observational cohort study. J Crit Care. 2013 Oct;28(5):816-24. doi: 10.1016/j.jcrc.2013.05.009. Epub 2013 Jul 10.
- Results publication: PubMed 28745077Panwar R, Sullohern B, Shiel E, Alexis Brown C, Quail A. Validity of a protocol to estimate patients' pre-morbid basal blood pressure. Blood Press. 2018 Feb;27(1):10-18. doi: 10.1080/08037051.2017.1358055. Epub 2017 Jul 26.
- Derived from this study: PubMed 41088147Panwar R, Gibberd A, Oldmeadow C, Tiruvoipati R, Aneman A, Kansal A; REACT SHOCK investigators. REACT SHOCK trial protocol and analysis plan-a multicenter randomised controlled trial comparing individualised blood pressure target versus standard blood pressure target among critically ill patients with shock. Trials. 2025 Oct 14;26(1):409. doi: 10.1186/s13063-025-09142-9.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Flonda Probert contact
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Individualised MAP target in people with Critical Illness and Shock, run by Rakshit Panwar at 1 site in Australia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 26 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Australia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Rakshit Panwar, PhD, MD, FCICM, MBBS (+61240420951, rakshitpanwar@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Mortality (time frame: 14 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05850962, which also lists 6 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Oct 2026.