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.
Am J Emerg Med. 2021 Aug;46:109-115. doi: 10.1016/j.ajem.2021.03.012. Epub 2021 Mar 9.
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.
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.
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.
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.
血压（BP）测量对于低血压患者的管理至关重要。有创动脉血压（IABP）和无创血压（NIBP）测量之间存在差异。然而，在休克患者[需要血管加压药或血清乳酸≥4 毫摩尔/升（mmol/L）]中，这些差异的临床适用性尚未得到报道。本研究旨在调查休克患者的 IABP 和 NIBP 差异以及临床管理的变化。
这是一项回顾性研究，涉及入住重症监护复苏病房（CCRU）的成年患者。符合条件的患者为 2017 年 1 月 1 日至 12 月 31 日期间入院时接受 IABP 且无高血压疾病的成年患者。主要结局指标为临床相关差异（CRD），定义为 IABP 和 NIBP 之间相差 10 毫米汞柱（mmHg），以及根据目标平均动脉压（MAP）≥65mmHg 改变血压管理。我们进行了向前逐步多变量逻辑回归来测量关联。
样本量计算推荐 200 例患者，我们分析了 263 例。121 例（46%）患者患有休克，23 例（9%）患者存在 CRD。血清乳酸每增加 1mmol/L，发生 CRD 的可能性就会增加 11%（OR 1.11，95%CI 1.002-1.2）。外周动脉疾病和任何肾脏疾病与 MAP 差异≥10mmHg 的可能性显著相关。
约 9%的休克患者存在临床相关的 MAP 差异。更高的血清乳酸与发生 CRD 的可能性更高相关。在进一步的研究结果可用之前，临床医生应考虑在休克患者中使用 IABP。
