Document Detail


Tracking hypotension and dynamic changes in arterial blood pressure with brachial cuff measurements.
MedLine Citation:
PMID:  19608825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Arterial cannulation is strongly recommended during shock. Nevertheless, this procedure is associated with significant risks and may delay other emergent procedures. We assessed the discriminative power of brachial cuff oscillometric noninvasive blood pressure (NIBP) for identifying patients with an invasive mean arterial blood pressure (MAP) below 65 mm Hg or increasing their invasive MAP after cardiovascular interventions. METHODS: This prospective study, conducted in three intensive care units, included adults in circulatory failure who underwent 45 degrees passive leg raising, 300 mL fluid loading, and additional 200 mL fluid loading. The collected data were four invasive and noninvasive MAP measurements at each study phase. RESULTS: Among 111 patients (50 septic, 15 cardiogenic, and 46 other source of shock), when averaging measurements of each study phase, NIBP measurements accurately predicted an invasive MAP lower than 65 mm Hg: area under the receiver operating characteristic curve 0.90 (95% CI: 0.71-1), positive and negative likelihood ratios 7.7 (95% CI: 5.4-11) and 0.31 (95% CI: 0.22-0.44) (cutoff 65 mm Hg). For identifying patients increasing their invasive MAP by more than 10%, the area under the receiver operating characteristic curve was 0.95 (95% CI: 0.92-0.96); positive and negative likelihood ratios (cutoff 10%) were 25.7 (95% CI: 10.8-61.4) and 0.26 (95% CI: 0.2-0.34). CONCLUSIONS: NIBP measurements have a good discriminative power for identifying hypotensive patients and performed even better in tracking MAP changes, provided that one averages four NIBP measurements.
Authors:
Karim Lakhal; Stephan Ehrmann; Isabelle Runge; Annick Legras; Pierre-François Dequin; Emmanuelle Mercier; Michel Wolff; Bernard Régnier; Thierry Boulain
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  109     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-17     Completed Date:  2009-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  494-501     Citation Subset:  AIM; IM    
Affiliation:
Service de Réanimation Médicale, Hôpital de La Source, Centre Hospitalier Régional, Assistance Publique des Hôpitaux de Paris, F45067 Orléans cedex 1, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Area Under Curve
Arteries / physiology
Blood Pressure / physiology*
Blood Pressure Determination / methods*,  statistics & numerical data
Data Interpretation, Statistical
Female
Hemodynamics / physiology
Humans
Hypotension / diagnosis*
Male
Middle Aged
Prospective Studies
ROC Curve
Resuscitation

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