PMD17 ESTIMATION OF US HOSPITAL COST SAVINGS ASSOCIATED WITH HYPOTENSION REDUCTION FOR MEAN ARTERIAL PRESSURE (MAP) ABOVE 65MMHG IN SEPTIC INTENSIVE CARE UNIT PATIENTS

Abstract Purpose Results of a study incorporating real-world results into a predictive model to assess the cost-effectiveness of procalcitonin (PCT)-guided antibiotic use in intensive care unit patients with sepsis are reported. Methods A single-center, retrospective cross-sectional study was conducted to determine whether reductions in antibiotic therapy duration and other care improvements resulting from PCT testing and use of an associated treatment pathway offset the costs of PCT testing. Selected base-case cost outcomes in adults with sepsis admitted to a medical intensive care unit (MICU) were assessed in preintervention and postintervention cohorts using a decision analytic model. Cost-minimization and cost–utility analyses were performed from the hospital perspective with a 1-year time horizon. Secondary and univariate sensitivity analyses tested a variety of clinically relevant scenarios and the robustness of the model. Results Base-case modeling predicted that use of a PCT-guided treatment algorithm would results in hospital cost savings of $45 per patient and result in a gain of 0.0001 quality-adjusted life-year. After exclusion of patients in the postintervention cohort for PCT test ordering outside of institutional guidelines, the mean inpatient antibiotic therapy duration was significantly reduced in the postintervention group relative to the preintervention group (6.2 days versus 4.9 days, p = 0.04) after adjustment for patient sex and age, Charlson Comorbidity Index score, study period, vasopressor use, and ventilator use. Total annual hospital cost savings of $4,840 were predicted. Conclusion Real-world implementation of PCT-guided antibiotic use may have improved patients’ quality of life while decreasing hospital costs in MICU patients with undifferentiated sepsis.

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Real-time fuzzy control of mean arterial pressure in postsurgical patients in an intensive care unit

[Proceedings 1993] Second IEEE International Conference on Fuzzy Systems ◽

10.1109/fuzzy.1993.327479 ◽

2002 ◽

Cited By ~ 1

Author(s):

H. Ying ◽

M. McEachern ◽

D.W. Eddleman ◽

L.C. Sheppard

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Fuzzy Control ◽

Real Time

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Early extubation improves outcome following extracardiac total cavopulmonary connection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz010 ◽

2019 ◽

Vol 29 (1) ◽

pp. 85-92 ◽

Cited By ~ 4

Author(s):

Masamichi Ono ◽

Stanimir Georgiev ◽

Melchior Burri ◽

Benedikt Mayr ◽

Julie Cleuziou ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Intensive Care Unit Stay ◽

Total Cavopulmonary Connection ◽

Early Extubation ◽

Group A ◽

Group B ◽

Cavopulmonary Connection

Abstract OBJECTIVES The aim of this study was to investigate the impact of an early extubation strategy on the outcome following extracardiac total cavopulmonary connection. METHODS From 1999 through 2017, 458 patients underwent extracardiac total cavopulmonary connection; 257 (56%) patients were managed with an early extubation strategy adopted in 2009 (group A). Their outcome was compared with those of 201 (44%) patients treated before 2009 (group B). In group A, the outcome of unstable patients, defined as >75th percentile for volume administered and inotrope scores, was compared with those of stable patients. RESULTS Ventilation time (median: 4 h vs 16 h, P < 0.001), fluid volume administered during the first 24 h (mean: 110 ml/kg vs 164 ml/kg, P = 0.003), chest tube duration (median: 3 days vs 4 days, P = 0.028) and length of intensive care unit stay (median: 6 days vs 7 days, P = 0.001) were less in group A than in group B. The reintubation rate (7% vs 6%, P = 0.547) and early mortality (0.8% vs 1.5%, P = 0.465) were similar between groups. The 80 unstable group A patients received more inotropic support (P < 0.001) and fluid volume (P < 0.001) than stable patients, but the ventilation time (6 h vs 5 h, P = 0.220), the reintubation rate (10% vs 6%, P = 0.283) and the length of intensive care unit stay (7 days vs 6 days, P = 0.590) were similar. In unstable patients, mean arterial pressure before extubation was significantly lower than stable patients (P = 0.001). However, mean arterial pressure in unstable patients increased significantly (P < 0.001) soon after extubation, and became similar to the value in stable patients. CONCLUSIONS Early extubation following extracardiac total cavopulmonary connection improves postoperative haemodynamics and recovery regardless of the initial haemodynamic status.

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Mean Arterial Pressure Should Above 65 mmHg at Vasopressor Weaning — Exploratory Study of Optimal Weaning Blood Pressure for Patients in Intensive Care Unit

10.21203/rs.3.rs-249723/v1 ◽

2021 ◽

Author(s):

Zichen Wang ◽

Luming Zhang ◽

Wen Ma ◽

Chengzhuo Li ◽

Haiyan Yin ◽

...

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Intensive Care ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Hospital Mortality ◽

Icu Patients ◽

Arterial Blood ◽

Mortality Probability ◽

Severe Hypotension

Abstract Objective:Vasopressors are one of the main treatments for severe hypotension or shock, which commonly occurs in intensive care unit (ICU) patients. However, only a few studies have been conducted on the appropriate timing for vasopressor weaning. This study aims to explore the effect of blood pressure at vasopressor weaning on the probability of in-hospital mortality.Design: Single-center retrospective observational study.Setting: ICU from Beth Israel Deaconess Medical Center between 2008 and 2019.Patients: ICU patients who received vasopressor treatment were selected. Patients younger than 18 years old, died before vasopressor weaning or without blood pressure measurement at weaning were excluded. Finally, 8,298 patients were included.Result: General additive model (GAM) result showed that blood pressures at weaning had “U-shape” non-linear relationship with in-hospital mortality probability. The optimal levels of weaning mean arterial pressure(WMAP), weaning systolic blood pressure(WSBP), and weaning diastolic blood pressure(WDBP) were 85, 120, and 65 mmHg, respectively. Subgroup analysis showed the optimal WMAP, WSBP,WDBP has deviations between diagnoses. The “cut-point” of a lower mortality probability for WMAP was 65 mmHg. ROC curves showed that mean arterial blood pressure as an indicator exhibited the best prediction performance. Cox regression demonstrated that patients with WMAP equal to or higher than 65 mmHg will have 61% lower risk of in-hospital mortality.Conclusion: WMAP is a powerful indicator for in-hospital mortality, and its value should be greater than 65 mmHg and close to 85 mmHg to reach the highest survival probability for ICU patients after vasopressor treatment.

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Target value of mean arterial pressure in patients undergoing continuous renal replacement therapy due to acute kidney injury

BMC Nephrology ◽

10.1186/s12882-020-02227-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yaerim Kim ◽

Donghwan Yun ◽

Soie Kwon ◽

Kyubok Jin ◽

Seungyeup Han ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Continuous Renal Replacement Therapy ◽

Kidney Injury ◽

Threshold Value ◽

Risk Of Mortality

Abstract Background Although patients undergoing continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI) frequently have instability in mean arterial pressure (MAP), no consensus exists on the target value of MAP related to high mortality after CRRT. Methods A total of 2,292 patients who underwent CRRT due to AKI in three referral hospitals were retrospectively reviewed. The MAPs were divided into tertiles, and the 3rd tertile group served as a reference in the analyses. The major outcome was all-cause mortality during the intensive care unit period. The odds ratio (OR) of mortality was calculated using logistic regression after adjustment for multiple covariates. The nonlinear relationship regression model was applied to determine the threshold value of MAP related to increasing mortality. Results The mean value of MAP was 80.7 ± 17.3 mmHg at the time of CRRT initiation. The median intensive care unit stay was 5 days (interquartile range, 2–12 days), and during this time, 1,227 (55.5%) patients died. The 1st tertile group of MAP showed an elevated risk of mortality compared with the 3rd tertile group (adjusted OR, 1.28 [1.03–1.60]; P = 0.029). In the nonlinear regression analysis, the threshold value of MAP was calculated as 82.7 mmHg. Patients with MAP < 82.7 mmHg had a higher mortality rate than those with ≥ 82.7 mmHg (adjusted OR, 1.21 [1.01–1.45]; P = 0.037). Conclusions Low MAP at CRRT initiation is associated with a high risk of mortality, particularly when it is < 82.7 mmHg. This value may be used for risk classification and as a potential therapeutic target.

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PIN24 - ESTIMATION OF HOSPITAL COST SAVINGS ASSOCIATED WITH HYPOTENSION REDUCTION IN SEPTIC INTENSIVE CARE UNIT PATIENTS IN US HOSPITALS

Value in Health ◽

10.1016/j.jval.2018.09.1343 ◽

2018 ◽

Vol 21 ◽

pp. S225

Author(s):

E. Keuffel ◽

C. Gunnarsson ◽

M. Stevens ◽

T. Davis ◽

K. Maheshwari

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Cost ◽

Cost Savings

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Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

American Journal of Critical Care ◽

10.4037/ajcc2015123 ◽

2015 ◽

Vol 24 (6) ◽

pp. 501-510 ◽

Cited By ~ 40

Author(s):

Jill Cox ◽

Sharon Roche

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Pressure Ulcers ◽

The Body ◽

Correlational Design ◽

Body Of Knowledge ◽

Cardiac Diagnosis ◽

Time Of Admission

Background Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. Objective To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. Methods A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. Results Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. Conclusion The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.

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