Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York.
Am J Respir Crit Care Med. 2020 Jul 1;202(1):91-99. doi: 10.1164/rccm.201908-1681OC.
Guidelines for vasopressor titration suggest a universal target-mean arterial pressure (MAP) >65 mm Hg. The implications for patients with premorbid low/high blood pressure are unknown. To investigate the relationship between premorbid blood pressure and vasopressor duration for patients with shock. We performed a retrospective cohort study of adults admitted with shock to Calgary ICUs (June 2012-December 2018). The primary exposure was premorbid blood pressure: low (systolic <100); normal (systolic 100-139 and diastolic <90); and high (systolic ≥140 or diastolic ≥90). The primary outcome was vasopressor duration; secondary outcomes included ICU/hospital length of stay and ICU/hospital mortality. We examined associations of premorbid blood pressure with vasopressor duration and length of stay using multivariable competing risk models and mortality using multivariable mixed-effects logistic regression. Of 3,542 admissions with shock, 177 (5.0%) had premorbid low, 2,887 (81.5%) normal, and 478 (13.5%) high blood pressure. Premorbid low admissions had lower MAPs (vs. normal or high premorbid admissions) over the duration of vasopressor use ( = 0.003) and were maintained nearest premorbid MAPs while receiving vasopressors ( < 0.001). After adjustment, premorbid low admissions had longer vasopressor use (median, 1.35 d vs. 1.04 d for normal; hazard ratio for discontinuation vs. normal, 0.78 [0.73-0.85]; < 0.001) and premorbid high admissions had shorter use (median, 0.84 d; hazard ratio, 1.22 [1.12-1.33]; < 0.001). Premorbid low admissions had longer adjusted length of stay and higher adjusted mortality than premorbid normal admissions. Premorbid blood pressure was inversely associated with vasopressor duration.
升压药滴定指南建议平均动脉压（MAP）的目标值>65mmHg。但对于存在基础低血压/高血压的患者，其具体影响尚不清楚。本研究旨在探讨休克患者基础血压与升压药使用时间之间的关系。我们对 2012 年 6 月至 2018 年 12 月期间入住卡尔加里 ICU 的休克成年患者进行了回顾性队列研究。主要暴露因素为基础血压：低（收缩压<100mmHg）；正常（收缩压 100-139mmHg 且舒张压<90mmHg）；高（收缩压≥140mmHg 或舒张压≥90mmHg）。主要结局为升压药使用时间；次要结局包括 ICU 住院时间和 ICU 住院死亡率。我们采用多变量竞争风险模型评估基础血压与升压药使用时间和住院时间之间的相关性，并采用多变量混合效应逻辑回归评估死亡率。在 3542 例休克患者中，177 例（5.0%）存在基础低血压，2887 例（81.5%）血压正常，478 例（13.5%）血压升高。与基础血压正常或升高的患者相比，基础低血压患者在使用升压药期间的 MAP 更低（ = 0.003），且在使用升压药期间 MAP 维持在基础血压附近（ < 0.001）。调整混杂因素后，基础低血压患者的升压药使用时间更长（中位时间：1.35d vs. 1.04d；正常组停药风险比：0.78[0.73-0.85]； < 0.001），而基础高血压患者的升压药使用时间更短（中位时间：0.84d；风险比：1.22[1.12-1.33]； < 0.001）。与基础血压正常的患者相比，基础低血压患者的调整后住院时间更长，死亡率更高。基础血压与升压药使用时间呈负相关。
