USF-LVHN SELECT
Arterial or cuff pressure: Clinical predictors among patients in shock in a critical care resuscitation unit.
Publication/Presentation Date
8-1-2021
Abstract
OBJECTIVES: Blood pressure (BP) measurement is essential for managing patients with hypotension. There are differences between invasive arterial blood pressure (IABP) and noninvasive blood pressure (NIBP) measurements. However, the clinical applicability of these differences in patients with shock [need for vasopressor or serum lactate ≥ 4 millimole per liter (mmol/L)] has not been reported. This study investigated differences in IABP and NIBP as well as changes in clinical management in critically ill patients with shock.
METHODS: This was a retrospective study involving adult patients admitted to the Critical Care Resuscitation Unit (CCRU). Adult patients who received IABP upon admission between 01/01/2017-12/31/2017 with non-hypertensive diseases were eligible. The primary outcome, clinically relevant difference (CRD), was defined as difference of 10 mm of mercury (mmHg) between IABP and NIBP and change of blood pressure management according to goal mean arterial pressure (MAP) ≥ 65 mmHg. We performed forward stepwise multivariable logistic regression to measure associations.
RESULTS: Sample size calculation recommended 200 patients, and we analyzed 263. 121 (46%) patients had shock, 23 (9%) patients had CRD. Each mmol/L increase in serum lactate was associated with 11% higher likelihood of having CRD (OR 1.11, 95%CI 1.002-1.2). Peripheral artery disease and any kidney disease was significantly associated with higher likelihood of MAP difference ≥ 10 mmHg.
CONCLUSION: Approximately 9% of patients with shock had clinically-relevant MAP difference. Higher serum lactate was associated with higher likelihood of CRD. Until further studies are available, clinicians should consider using IABP in patients with shock.
Volume
46
First Page
109
Last Page
115
ISSN
1532-8171
Published In/Presented At
Keville, M. P., Gelmann, D., Hollis, G., Beher, R., Raffman, A., Tanveer, S., Jones, K., Parker, B. M., Haase, D. J., & Tran, Q. K. (2021). Arterial or cuff pressure: Clinical predictors among patients in shock in a critical care resuscitation unit. The American journal of emergency medicine, 46, 109–115. https://doi.org/10.1016/j.ajem.2021.03.012
Disciplines
Medical Education | Medicine and Health Sciences
PubMedID
33744746
Department(s)
USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
Document Type
Article