University of Maryland School of Medicine, Baltimore, MD, 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. 2022 Sep;59:85-93. doi: 10.1016/j.ajem.2022.06.054. Epub 2022 Jul 3.
Blood pressure (BP) monitoring and management is essential in the treatment of acute aortic disease (AoD). Previous studies had shown differences between invasive arterial BP monitoring (ABPM) and non-invasive cuff BP monitoring (CBPM), but not whether ABPM would result in patients' change of clinical management. We hypothesized that ABPM would change BP management in AoD patients.
This was a prospective observational study of adult patients with AoD admitted to the Critical Care Resuscitation Unit from January 2019 to February 2021. Patients with AoD and both ABPM and CBPM measurements were included. Clinician's BP management goals were assessed in real time before and after arterial catheter placement according to current guidelines. We defined change of management as change of current antihypertensive infusion rate or adding a new agent. We used multivariable logistic and ordinal regressions to determine relevant predictors.
We analyzed 117 patients, and 56 (47%) had type A dissection. ABPM was frequently ≥10 mmHg higher than CBPM values. Among 40 (34%) patients with changes in management, 58% (23/40) had [ABPM-CBPM] differences ≥20 mmHg. ABPM prompted increasing current antihypertensive infusion in 68% (27/40) of patients. Peripheral artery disease (OR 13, 95% CI 1.18-50+) was associated with changes in clinical management, and ordinal regression showed hypertension and serum lactate to be associated with differences between ABPM and CBPM.
ABPM was frequently higher than CBPM, resulting in 34% of changes of management, most commonly increasing anti-hypertensive infusion rates.
血压（BP）监测和管理在急性主动脉疾病（AoD）的治疗中至关重要。先前的研究表明，有创动脉血压监测（ABPM）和非侵入性袖带血压监测（CBPM）之间存在差异，但 ABPM 是否会导致患者临床管理的改变尚不清楚。我们假设 ABPM 会改变 AoD 患者的血压管理。
这是一项前瞻性观察性研究，纳入了 2019 年 1 月至 2021 年 2 月期间入住重症监护复苏病房的 AoD 成年患者。纳入了同时接受 ABPM 和 CBPM 测量的 AoD 患者。根据现行指南，在放置动脉导管前后实时评估临床医生的血压管理目标。我们将管理上的改变定义为改变当前降压输注率或添加新的药物。我们使用多变量逻辑回归和有序回归来确定相关预测因素。
我们分析了 117 例患者，其中 56 例（47%）为 A 型夹层。ABPM 通常比 CBPM 值高≥10mmHg。在管理上发生变化的 40 例患者中（34%），[ABPM-CBPM]差值≥20mmHg 的占 58%（23/40）。ABPM 促使 68%（27/40）的患者增加当前降压输注。外周动脉疾病（OR 13，95%CI 1.18-50+）与临床管理的改变相关，有序回归显示高血压和血清乳酸与 ABPM 和 CBPM 之间的差异相关。
ABPM 通常高于 CBPM，导致 34%的管理改变，最常见的是增加降压输注率。
