USF-LVHN SELECT
Invasive arterial blood pressure monitoring may aid in the medical management of hypertensive patients with acute aortic disease.
Publication/Presentation Date
9-1-2022
Abstract
INTRODUCTION: Blood pressure (BP) monitoring and management is essential in the treatment of acute aortic disease (AoD). Previous studies had shown differences between invasive arterial BP monitoring (ABPM) and non-invasive cuff BP monitoring (CBPM), but not whether ABPM would result in patients' change of clinical management. We hypothesized that ABPM would change BP management in AoD patients.
METHODS: This was a prospective observational study of adult patients with AoD admitted to the Critical Care Resuscitation Unit from January 2019 to February 2021. Patients with AoD and both ABPM and CBPM measurements were included. Clinician's BP management goals were assessed in real time before and after arterial catheter placement according to current guidelines. We defined change of management as change of current antihypertensive infusion rate or adding a new agent. We used multivariable logistic and ordinal regressions to determine relevant predictors.
RESULTS: We analyzed 117 patients, and 56 (47%) had type A dissection. ABPM was frequently ≥10 mmHg higher than CBPM values. Among 40 (34%) patients with changes in management, 58% (23/40) had [ABPM-CBPM] differences ≥20 mmHg. ABPM prompted increasing current antihypertensive infusion in 68% (27/40) of patients. Peripheral artery disease (OR 13, 95% CI 1.18-50+) was associated with changes in clinical management, and ordinal regression showed hypertension and serum lactate to be associated with differences between ABPM and CBPM.
CONCLUSIONS: ABPM was frequently higher than CBPM, resulting in 34% of changes of management, most commonly increasing anti-hypertensive infusion rates.
Volume
59
First Page
85
Last Page
93
ISSN
1532-8171
Published In/Presented At
Palmer, J., Gelmann, D., Engelbrecht-Wiggans, E., Hollis, G., Hart, E., Ali, A., Haase, D. J., & Tran, Q. (2022). Invasive arterial blood pressure monitoring may aid in the medical management of hypertensive patients with acute aortic disease. The American journal of emergency medicine, 59, 85–93. https://doi.org/10.1016/j.ajem.2022.06.054
Disciplines
Medical Education | Medicine and Health Sciences
PubMedID
35816837
Department(s)
USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
Document Type
Article