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World Journal of Emergency Medicine ›› 2023, Vol. 14 ›› Issue (3): 173-178.doi: 10.5847/wjem.j.1920-8642.2023.035

• Original Articles •     Next Articles

Most patients with non-hypertensive diseases at a critical care resuscitation unit require arterial pressure monitoring: a prospective observational study

Emily Engelbrecht-Wiggans1, Jamie Palmer1, Grace Hollis2, Fernando Albelo1, Afrah Ali3, Emily Hart4, Dominique Gelmann1, Iana Sahadzic2, James Gerding4, Quincy K. Tran2,3,4(), Daniel J. Haase3,4   

  1. 1University of Maryland School of Medicine, Baltimore 21201, USA
    2The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
    3Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
    4Program in Trauma, the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore 21201, USA
  • Received:2022-10-29 Online:2023-04-28 Published:2023-05-01
  • Contact: Quincy K. Tran E-mail:qtran@som.umaryland.edu

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Abstract:

BACKGROUND: Blood pressure (BP) monitoring is essential for patient care. Invasive arterial BP (IABP) is more accurate than non-invasive BP (NIBP), although the clinical significance of this difference is unknown. We hypothesized that IABP would result in a change of management (COM) among patients with non-hypertensive diseases in the acute phase of resuscitation.

METHODS: This prospective study included adults admitted to the Critical Care Resuscitation Unit (CCRU) with non-hypertensive disease from February 1, 2019, to May 31, 2021. Management plans to maintain a mean arterial pressure >65 mmHg (1 mmHg=0.133 kPa) were recorded in real time for both NIBP and IABP measurements. A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion. Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance (RVI) values.

RESULTS: Among the 206 patients analyzed, a COM occurred in 94 (45.6% [94/206]) patients. The most common COM was an increase in current infusion dosages (40 patients, 19.4%). Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without (45 [47.9%] vs. 32 [28.6%], P=0.004). Receiving norepinephrine (relative variable importance [RVI] 100%) was the most significant factor associated with a COM. No complications were identified with IABP use.

CONCLUSION: A COM occurred in 94 (45.6%) non-hypertensive patients in the CCRU. Receiving vasopressors was the greatest factor associated with COM. Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase. Further studies are necessary to confirm the risk-to-benefit ratios of IABP among these high-risk patients.

Key words: Non-hypertensive diseases, Invasive arterial blood pressure, Non-invasive blood pressure