Meaghan P Keville1, Dominique Gelmann2, Grace Hollis3, Richa Beher4, Alison Raffman5, Saman Tanveer6, Kevin Jones7, Brandon M Parker8, Daniel J Haase9, Quincy K Tran10. 1. The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America. Electronic address: Meaghan.keville@umm.edu. 2. The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201., United States of America. Electronic address: dominique.gelmann@som.umaryland.edu. 3. The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201., United States of America. Electronic address: grace.hollis@umm.edu. 4. The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201., United States of America. Electronic address: richa.beher@umm.edu. 5. The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201., United States of America. Electronic address: alison.raffman@som.umaryland.edu. 6. The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201., United States of America. Electronic address: saman.tanveer@umm.edu. 7. The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America. Electronic address: kevin.jones@som.umaryland.edu. 8. The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America. 9. The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America. Electronic address: dhaase@som.umaryland.edu. 10. The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America; The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201., United States of America; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America. Electronic address: qtran@som.umaryland.edu.
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.
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 illpatients 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.