Blood pressure goals: Is cerebral saturation the new mean arterial pressure?

2021 ◽  
Author(s):  
Kevin James McKim ◽  
Stephen Lucafo ◽  
S Bhombal ◽  
Lisa Bain ◽  
Valerie Y. Chock
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Premature Infants ◽  
Near Infrared ◽  
Cerebral Hypoxia ◽  
Normal Range ◽  
Percent Time ◽  
Postmenstrual Age ◽  
Blood Pressure Goals ◽  
Cerebral Saturation

Objective: To correlate hypotension and cerebral saturation from near-infrared spectroscopy (cNIRS) in neonates on dopamine. Study Design: Retrospective review of neonates receiving dopamine between August 2018-2019 was performed. Hypotension thresholds included mean arterial pressure (MAP) of postmenstrual age (PMA) ± 5mmHg, 30mmHg, and gestational age (GA) ± 5mmHg. Time below threshold MAP was compared to time with cerebral hypoxia (cNIRS <55%). Results: Hypotension occurred 6-33% of time on dopamine in 59 cases. Hypotension did not correlate with abnormal cNIRS overall, within PMA subgroups, or by outcomes. Hypotensive periods with MAP<GA had fewer corresponding percent time with abnormal cNIRS events (3.7±1.3%) compared to MAP <PMA (11.9±4.9%, p<0.003) or 30 mm Hg thresholds (12.2±4.7%, p<0.0001). In the most premature infants, mean cNIRS values during hypotension were still within normal range (57±6%). Conclusion: cNIRS may be a more clinically relevant measure than MAP for assessment of neonatal hypotension.

An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia

2018 ◽  
Vol 128 (1) ◽  
pp. 85-96 ◽  
Author(s):  
Vanessa A. Olbrecht ◽  
Justin Skowno ◽  
Vanessa Marchesini ◽  
Lili Ding ◽  
Yifei Jiang ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pulse Oximetry ◽  
General Anesthesia ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Subsequent Development ◽  
Low Oxygen ◽  
Cerebral Desaturation ◽  
Cerebral Saturation

Abstract Background General anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia–ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia in infants. Methods This multicenter study enrolled 453 infants aged less than 6 months having general anesthesia for 30 min or more. Regional cerebral oxygenation was measured by near-infrared spectroscopy. We defined events (more than 3 min) for low cerebral oxygenation as mild (60 to 69% or 11 to 20% below baseline), moderate (50 to 59% or 21 to 30% below baseline), or severe (less than 50% or more than 30% below baseline); for low mean arterial pressure as mild (36 to 45 mmHg), moderate (26 to 35 mmHg), or severe (less than 25 mmHg); and low pulse oximetry saturation as mild (80 to 89%), moderate (70 to 79%), or severe (less than 70%). Results The incidences of mild, moderate, and severe low cerebral oxygenation were 43%, 11%, and 2%, respectively; mild, moderate, and severe low mean arterial pressure were 62%, 36%, and 13%, respectively; and mild, moderate, and severe low arterial saturation were 15%, 4%, and 2%, respectively. Severe low oxygen saturation measured by pulse oximetry was associated with mild and moderate cerebral desaturation; American Society of Anesthesiology Physical Status III or IV versus I was associated with moderate cerebral desaturation. Severe low cerebral saturation events were too infrequent to analyze. Conclusions Mild and moderate low cerebral saturation occurred frequently, whereas severe low cerebral saturation was uncommon. Low mean arterial pressure was common and not well associated with low cerebral saturation. Unrecognized severe desaturation lasting 3 min or longer in infants seems unlikely to explain the subsequent development of neurocognitive abnormalities.

scholarly journals Impact of 2 Distinct Levels of Mean Arterial Pressure on Near-Infrared Spectroscopy During Cardiac Surgery

2019 ◽  
Vol 128 (6) ◽  
pp. 1081-1088 ◽  
Author(s):  
Frederik Holmgaard ◽  
Anne G. Vedel ◽  
Theis Lange ◽  
Jens C. Nilsson ◽  
Hanne B. Ravn
Keyword(s):  
Cardiac Surgery ◽  
Infrared Spectroscopy ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Near Infrared Spectroscopy ◽  
Near Infrared

PERUBAHAN MEAN ARTERIAL PRESSURE (MAP) PASIEN HIPERGLIKEMIA KRISIS DENGAN TERAPI REHIDRASI

2019 ◽  
Vol 5 (2) ◽  
Author(s):  
Erik Irham Lutfi ◽  
Susmiati Susmiati ◽  
Meirna Eka Fitriasnani ◽  
Nur Wasilatul Kauniyah
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Cerebral Edema ◽  
Tissue Perfusion ◽  
Normal Range ◽  
Cerebral Tissue ◽  
Time Period ◽  
Drastic Increase ◽  
Body Fluid Volume ◽  
The Difference

Abstract : Rehydration therapy aims to replace the volume of circulating tissue perfusion due to hyperosmolarity in crisis hyperglycemia patients. The administration of fluid therapy to patients with crisis hyperglycemia can trigger cerebral edema due to the mechanism of decreased osmolarity in cerebral tissue. Efforts to monitor the emergence of cerabral edema with MAE monitoring. MAE is an indicator of CPP if there is a drastic increase in MAP which will result in an increase in CPP and increase the risk of cerebral edema. This study aims to determine the difference in MAP in hyperglycemic crisis patients with fluid rehydration therapy from the first minute of administration to the last minute of administration by accumulating the amount of fluid given in that time period. A retrospective comparative category research design. The study sample consisted of 28 respondents. Based on data analysis using repeated anova, there was a difference in MAP in hyperglycemic crisis patients who received fluid rehydration therapy from the lowest amount to the highest number during therapy. Changes in the value of MAP in this study for all the amount of therapy in the normal range starting from the MAP before the therapy approaching the less or minimum value until MAP at the end of therapy at the maximum limit of the normal value of MAP. This indicates that the administration of therapy in this study will increase the amount of body fluid volume and increase in MAP without causing signs of cerebral edema.                                                     Keyword : Rehydration Therapy, MAP (Mean Arterial Pressure), hyperglycemia crisisAbstrak : Terapi rehidrasi bertujuan untuk mengganti volume sirkulasi perfusi jaringan akibat adanya hiperosmolaritas pada pasien hiperglikemia krisis.  Pemberian terapi cairan pada pasien hiperglikemia krisis bisa memicu terjadinya edema cerebral akibat mekanisme penurunan osmolaritas pada jaringan cerebral. Upaya monitoring munculnya edema cerabral dengan pematauan MAE. MAE merupakan salah satu indikator terhadap CPP apabila di dapatkan adanya peningkatan MAP yang drastis akan berakibat peningkatan CPP dan meningkatkan resiko edema cerebral. Penelitian ini bertujuan mengetahui perbedaan MAP pada pasien krisis hiperglikemia dengan terapi rehidrasi cairan  mulai dari menit pertama pemberian sampai menit terakhir pemberian dengan mengakumulasi jumlah cairan yang diberikan pada periode waktu tersebut. Desain penelitian kategori komparatif retrospektif. Berdasarkan uji analisa data dengan menggunakan repeated anova didapatkan ada perbedaan MAP pada pasien krisis hiperglikemia yang mendapatkan terapi rehidrasi cairan mulai jumlah terendah sampai jumlah tertingi selama terapi diberikan. Perubahan nilai MAP dalam penelitian ini untuk semua jumlah terapi dalam batas normal dimulai dari MAP sebelum terapi yang mendekati nilai kurang atau minimum sampai dengan MAP pada akhir terapi pada batas maksimal dari nilai normal MAP.  Hal ini menandakan pemberian terapi pada penelitian ini akan meningkatkan jumlah volume cairan tubuh dan peningkatan MAP  tanpa menyebakan tanda edema cerebral.Kata Kunci : Terapi rehidrasi, MAP (Mean Arterial Pressure), hiperglikemia krisis

Posterior Reversible Encephalopathic Syndrome in the Setting of Induced Elevated Mean Arterial Pressure in Patients With Spinal Cord Injury

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Alexander C Whiting ◽  
Manuel P Fanarjian ◽  
Randall J Hlubek ◽  
Jakub Godzik ◽  
U Kumar Kakarla ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Case Series ◽  
Neurological Status ◽  
Cord Injury ◽  
Treatment Paradigm ◽  
Blood Pressure Goals

Abstract BACKGROUND AND IMPORTANCE Acute spinal cord injury (SCI) is managed by avoiding hypotension and elevating mean arterial pressure (MAP) to attain optimal perfusion of the spinal cord. Few studies have been published regarding complications related to this treatment paradigm. CLINICAL PRESENTATION Three patients with SCI developed posterior reversible encephalopathic syndrome (PRES) during treatment with intravenous fluids and vasopressors administered to maintain elevated MAPs. All of them experienced temporary elevations well above the standard blood pressure goals for acute SCI and deterioration of neurological status. CONCLUSION PRES is a potential complication of elevated MAPs in patients with SCI, particularly if the blood pressure rises above the goals of standard treatment paradigms. The neurosurgical staff should be suspicious of possible PRES early in the course of acute SCI in patients with unexplained neurological decline. This case series is the first report of PRES in patients with acute SCI.

Cerebral Intravascular Oxygenation Correlates With Mean Arterial Pressure in Critically Ill Premature Infants

PEDIATRICS ◽  
2000 ◽  
Vol 106 (4) ◽  
pp. 625-632 ◽  
Author(s):  
M. Tsuji ◽  
J. P. Saul ◽  
A. du Plessis ◽  
E. Eichenwald ◽  
J. Sobh ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Premature Infants

scholarly journals Impacts of perioperative warming on vital findings and blood parameters of patients having cholecystectomy

2021 ◽  
pp. 56-64
Keyword(s):  
Mean Arterial Pressure ◽  
Body Temperature ◽  
Arterial Pressure ◽  
Healing Process ◽  
Blood Parameters ◽  
Repeated Measurements ◽  
Normal Range ◽  
Significant Difference ◽  
The Mean ◽  
Average Body

This study was carried out to determine the effects of preoperative, preoperative, and postoperative warming on vital signs and blood parameters in patients undergoing laparoscopic cholecystectomy. This study was carried out in operating room A of a research and practice hospital. Necessary permissi-ons were obtained from the university research ethics committee, hospital, and patients. Eighty patients who had undergone medical operations in the hospital in the last six months were included in the sampling method. Body temperatures and physiological findings of the patients and room temperature were also given as percen-tages. Repeated measurements of variance and t-test evaluated postoperative physiological results of each patient. The average body temperature of the patients was 36.36+ 2.81°C, and the average body temperature after the operation was 36.33+ 2.80°C (p >0.05). The mean arterial pressure (MAP) of the patients before the operation was 102.64+11.529 mm Hg. The mean arterial pressure of the patients in the recovery room after the operation was 98.55+ 9.940. During the operation, the MAP was between 96 and 98 Hg. There was a significant difference in terms of the mean arterial pressure of the patients (p <0.05). The average hemoglobin, lymphocyte, platelet counts, activated partial thromboplastin time levels, and values were within the normal range, and there was a significant difference in terms of importance and levels before and after the operation (p < 0.05). The average preoperative, preoperative and postoperative blood urea nitrogen (BUN) values of the patients were 13.79+ 6.126, 13.70+6.752, and 13.52+7.637, respectively. They were within the normal range, and there was no statistical difference (p >0.05). As a result, it can be said that keeping the preoperative, preoperative, and postoperative body tempera-tures of the patients positively affects blood pressure, respiration, and oxygenation and help to normalize these values. In addition, it keeps erythrocyte, hemoglobin, leukocytes, lymphocytes, thrombocyte, APTT, BUN, AST, ALT values within the normal range. It contributes positively to the healing process of the wound. In order to increase the accuracy of this study, it is recommended to conduct studies that include more control and experi-mental groups.

Optimizing Mean Arterial Pressure in Acutely Comatose Patients Using Cerebral Autoregulation Multimodal Monitoring With Near-Infrared Spectroscopy*

2019 ◽  
Vol 47 (10) ◽  
pp. 1409-1415 ◽  
Author(s):  
Lucia Rivera-Lara ◽  
Romergryko Geocadin ◽  
Andres Zorrilla-Vaca ◽  
Ryan J. Healy ◽  
Batya R. Radzik ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Near Infrared Spectroscopy ◽  
Cerebral Autoregulation ◽  
Near Infrared ◽  
Multimodal Monitoring
Sign in / Sign up

Export Citation Format

Share Document