Document Detail


Methods of blood pressure measurement in the ICU.
MedLine Citation:
PMID:  23269127     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Minimal clinical research has investigated the significance of different blood pressure monitoring techniques in the ICU and whether systolic vs. mean blood pressures should be targeted in therapeutic protocols and in defining clinical study cohorts. The objectives of this study are to compare real-world invasive arterial blood pressure with noninvasive blood pressure, and to determine if differences between the two techniques have clinical implications.
DESIGN: We conducted a retrospective study comparing invasive arterial blood pressure and noninvasive blood pressure measurements using a large ICU database. We performed pairwise comparison between concurrent measures of invasive arterial blood pressure and noninvasive blood pressure. We studied the association of systolic and mean invasive arterial blood pressure and noninvasive blood pressure with acute kidney injury, and with ICU mortality.
SETTING: Adult intensive care units at a tertiary care hospital.
PATIENTS: Adult patients admitted to intensive care units between 2001 and 2007.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Pairwise analysis of 27,022 simultaneously measured invasive arterial blood pressure/noninvasive blood pressure pairs indicated that noninvasive blood pressure overestimated systolic invasive arterial blood pressure during hypotension. Analysis of acute kidney injury and ICU mortality involved 1,633 and 4,957 patients, respectively. Our results indicated that hypotensive systolic noninvasive blood pressure readings were associated with a higher acute kidney injury prevalence (p = 0.008) and ICU mortality (p < 0.001) than systolic invasive arterial blood pressure in the same range (≤70 mm Hg). Noninvasive blood pressure and invasive arterial blood pressure mean arterial pressures showed better agreement; acute kidney injury prevalence (p = 0.28) and ICU mortality (p = 0.76) associated with hypotensive mean arterial pressure readings (≤60 mm Hg) were independent of measurement technique.
CONCLUSIONS: Clinically significant discrepancies exist between invasive and noninvasive systolic blood pressure measurements during hypotension. Mean blood pressure from both techniques may be interpreted in a consistent manner in assessing patients' prognosis. Our results suggest that mean rather than systolic blood pressure is the preferred metric in the ICU to guide therapy.
Authors:
Li-wei H Lehman; Mohammed Saeed; Daniel Talmor; Roger Mark; Atul Malhotra
Related Documents :
7848347 - Pharmacology of the new selective a2a adenosine receptor agonist 2-hexynyl-5'-n-ethylca...
9563737 - Red-blood-cell augmentation of hypoxic pulmonary vasoconstriction: hematocrit dependenc...
9833137 - Influence of left ventricular pressures and heart rate on myocardial high-energy phosph...
2928087 - Endogenous adenosine improves work rate to oxygen consumption ratio in catecholamine st...
1155327 - Effects of tachycardia on the adequacy of subendocardial oxygen delivery in experimenta...
2837697 - Enalapril as first choice treatment of mild, moderate and severe essential hypertension...
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  41     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-27     Completed Date:  2013-03-04     Revised Date:  2013-11-11    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  34-40     Citation Subset:  AIM; IM    
Affiliation:
Massachusetts Institute of Technology Cambridge, MA, USA. lilehman@mit.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury
Adult
Aged
Blood Pressure Determination / methods*
Boston
Catheterization, Peripheral
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Oscillometry
Point-of-Care Systems
Regression Analysis
Retrospective Studies
Grant Support
ID/Acronym/Agency:
K24 HL 093218/HL/NHLBI NIH HHS; K24 HL093218/HL/NHLBI NIH HHS; P01 HL 095491/HL/NHLBI NIH HHS; P01 HL095491/HL/NHLBI NIH HHS; R01 HL085188/HL/NHLBI NIH HHS; R01 HL090897/HL/NHLBI NIH HHS; R01 HL090897/HL/NHLBI NIH HHS; R01EB001659/EB/NIBIB NIH HHS
Comments/Corrections
Comment In:
Crit Care Med. 2013 Jan;41(1):333-4   [PMID:  23269136 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Risk of major osteoporotic fracture after cardiovascular disease: a population-based cohort study in...
Next Document:  Effect of rescue breathing during cardiopulmonary resuscitation on lung function after restoration o...