Impact of Mean Arterial Pressure Fluctuation on Mortality in Critically Ill Patients

2018 ◽  
Vol 46 (12) ◽  
pp. e1167-e1174 ◽  
Author(s):  
Ya Gao ◽  
Qinfen Wang ◽  
Jiamei Li ◽  
Jingjing Zhang ◽  
Ruohan Li ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Pressure Fluctuation ◽  
Critically Ill Patients

scholarly journals The evolution of mean arterial pressure in critically ill patients on vasopressors before and during a trial comparing a specific mean arterial pressure target to usual care

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie-Hélène Masse ◽  
Neill K. J. Adhikari ◽  
Xavier Théroux ◽  
Marie-Claude Battista ◽  
Frédérick D’Aragon ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Usual Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Hypertension ◽  
The Mean ◽  
Change In Mean

Abstract Background In randomized clinical controlled trials, the choice of usual care as the comparator may be associated with better clinician uptake of the study protocol and lead to more generalizable results. However, if care processes evolve to resemble the intervention during the course of a trial, differences between the intervention group and usual care control group may narrow. We evaluated the effect on mean arterial pressure of an unblinded trial comparing a lower mean arterial pressure target to reduce vasopressor exposure, vs. a clinician-selected mean arterial pressure target, in critically ill patients at least 65 years old. Methods For this multicenter observational study using data collected both prospectively and retrospectively, patients were recruited from five of the seven trial sites. We compared the mean arterial pressure of patients receiving vasopressors, who met or would have met trial eligibility criteria, from two periods: [1] at least 1 month before the trial started, and [2] during the trial period and randomized to usual care, or not enrolled in the trial. Results We included 200 patients treated before and 229 after trial initiation. There were no differences in age (mean 74.5 vs. 75.2 years; p = 0.28), baseline Acute Physiology and Chronic Health Evaluation II score (median 26 vs. 26; p = 0.47) or history of chronic hypertension (n = 126 [63.0%] vs. n = 153 [66.8%]; p = 0.41). Mean of the mean arterial pressure was similar between the two periods (72.5 vs. 72.4 mmHg; p = 0.76). Conclusions The initiation of a trial of a prescribed lower mean arterial pressure target, compared to a usual clinician-selected target, was not associated with a change in mean arterial pressure, reflecting stability in the net effect of usual clinician practices over time. Comparing prior and concurrent control groups may alleviate concerns regarding drift in usual practices over the course of a trial or permit quantification of any change.

Associations Between Mean Arterial Pressure and Poor ICU Outcomes in Critically Ill Patients With Cirrhosis

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kavish R. Patidar ◽  
Jennifer Lynn Peng ◽  
Francis Pike ◽  
Eric S. Orman ◽  
Mathew Glick ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Evaluating the clinical and cost-effectiveness of permissive hypotension in critically ill patients aged 65 years or over with vasodilatory hypotension: Protocol for the 65 randomised clinical trial

2020 ◽  
Vol 21 (4) ◽  
pp. 281-282
Author(s):  
Alvin Richards-Belle ◽  
Paul R Mouncey ◽  
Richard D Grieve ◽  
David A Harrison ◽  
M Zia Sadique ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomised Clinical Trial ◽  
Vasopressor Therapy ◽  
Permissive Hypotension ◽  
Risk Of Death ◽  
South Central

Vasodilatory shock is common in critically ill patients and vasopressors are a mainstay of therapy. A meta-analysis suggested that use of a higher, as opposed to a lower, mean arterial pressure target to guide titration of vasopressor therapy, could be associated with a higher risk of death in older critically ill patients. The 65 trial is a pragmatic, multi-centre, parallel-group, open-label, randomised clinical trial of permissive hypotension (a mean arterial pressure target of 60 -65 mmHg during vasopressor therapy) versus usual care in critically ill patients aged 65 years or over with vasodilatory hypotension. The trial is conducted in 2600 patients from 65 United Kingdom adult, general critical care units. The primary outcome is all-cause mortality at 90 days. An economic evaluation is embedded. The 65 trial received favourable ethical opinion from the South Central - Oxford C Research Ethics Committee and approval from the Health Research Authority. The results will be presented at national and international conferences and published in peer-reviewed medical journals. Trial registration: ISRCTN10580502

scholarly journals Hemodynamic Tolerability of Sustained Low Efficiency Dialysis in Critically Ill Patients with Acute Kidney Injury

2017 ◽  
Vol 6 (2) ◽  
pp. 84-90
Author(s):  
Kaniz Fatema ◽  
Mohammad Omar Faruq ◽  
Md Mozammel Hoque ◽  
ASM Areef Ahsan ◽  
Parvin Akter Khanam ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Low Efficiency

Background: Sustained low efficiency dialysis (SLED) has been evolved in recent years as technical hybrid of continuous renal replacement therapy and intermittent hemodialysis. It offers optimized hemodynamic stability of the critically ill patients with acute kidney injury (AKI). Our aim was to evaluate the hemodynamic tolerability of SLED in hemodynamically unstable patients with AKI.Methods: This prospective experimental study was conducted in Intensive Care Unit of BIRDEM General Hospital, Dhaka over a period of one year.Results: Forty three hemodynamically unstable patients with AKI were treated with one fifty three sessions of SLED. Mean arterial pressure of the patients before starting dialysis were 80.58±10.92 mmHg and 69.8% patients were on inotrope support. There were no significant differences (p>0.05) in mean arterial pressure during the procedure. No significant changes (p>0.05) occurred in pulse, respiratory rate and temperature during the sessions. Only thirty six out of 153 SLED sessions were associated with complications and hypotension was the commonest one (20.26%). Hypotensive episodes were effectively managed with addition or dose escalation of inotropes. No dialysis had to be discontinued because of hypotension/arrhythmia.Conclusion: SLED is an effective renal replacement therapy for the critically ill patients with AKI which maintains their hemodynamic stability.Birdem Med J 2016; 6(2): 84-90

scholarly journals Searching Optimal Target of Perfusion Pressure for Managing Acute Kidney Injury in Critically Ill Patients: An Analysis of Three Large Open Databases

2020 ◽  
Author(s):  
Buyun Wu ◽  
Yudie Peng ◽  
Jin Liu ◽  
Ting Li ◽  
Kang Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Perfusion Pressure ◽  
Kidney Injury ◽  
Research Database ◽  
Optimal Target ◽  
Mimic Iii

Abstract Background: The optimal perfusion pressure target for acute kidney injury (AKI) in critically ill patients remains uncertain. We investigated the association between mean perfusion pressure (MPP) and AKI among critically ill patients and estimated its optimal range.Methods: We analyzed data stored in the Medical Information Mart for Intensive Care (MIMIC) -III, eICU Collaborative Research Database (eICU-CRD), and MIMIC-IV databases. Critically ill patients receiving invasive measurements of MPP for at least 12 hours within the first 24 hours of ICU stay were included. The exposure of interest was the time-weighted average MPP (TWA-MPP) in the first 24 hours. The primary outcome was the incidence of AKI in the next 48 hours. Results: We enrolled 7,992, 8,604, and 6,730 patients from the MIMIC-III, eICU-CRD, and MIMIC-IV databases, respectively. TWA-MPP had higher areas under the curve than mean arterial pressure in predicting AKI in the next 48 hours (0.63 vs 0.57, 0.62 vs 0.58, and 0.64 vs 0.58 in three databases, all p < 0.001). We observed the lowest adjusted risk of AKI when TWA-MPP above 72, 65, and 69 mmHg in the MIMIC-III, eICU-CRD, and MIMIC-IV databases, respectively. Pooled analyses indicated that per 10% increase of proportion of MPP above 65 mmHg was associated with decreased incidence of AKI (adjusted odds ratio = 0.93, 95% confidence interval = 0.92–0.94, p < 0.001). Furthermore, pooled analyses showed that the lowest risk of new-onset, persistence, and progression of AKI was estimated when TWA-MPP above 74, 70 and 65 mmHg, respectively. Conclusions: MPP outperformed mean arterial pressure as a perfusion predictor of AKI. MPP of 65 mmHg or higher may be the optimal target for managing AKI in critically ill patients. The target rises to higher when reversing or preventing AKI.

scholarly journals Evaluating the clinical and cost-effectiveness of permissive hypotension in critically ill patients aged 65 years or over with vasodilatory hypotension: Protocol for the 65 randomised clinical trial

2019 ◽  
pp. 175114371987008 ◽  
Author(s):  
Alvin Richards-Belle ◽  
Paul R Mouncey ◽  
Richard D Grieve ◽  
David A Harrison ◽  
M Zia Sadique ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomised Clinical Trial ◽  
Vasopressor Therapy ◽  
Permissive Hypotension ◽  
Risk Of Death ◽  
South Central

Vasodilatory shock is common in critically ill patients and vasopressors are a mainstay of therapy. A meta-analysis suggested that use of a higher, as opposed to a lower, mean arterial pressure target to guide titration of vasopressor therapy, could be associated with a higher risk of death in older critically ill patients. The 65 trial is a pragmatic, multi-centre, parallel-group, open-label, randomised clinical trial of permissive hypotension (a mean arterial pressure target of 60–65 mmHg during vasopressor therapy) versus usual care in critically ill patients aged 65 years or over with vasodilatory hypotension. The trial is conducted in 2600 patients from 65 United Kingdom adult, general critical care units. The primary outcome is all-cause mortality at 90 days. An economic evaluation is embedded. The 65 trial received favourable ethical opinion from the South Central – Oxford C Research Ethics Committee and approval from the Health Research Authority. The results will be presented at national and international conferences and published in peer-reviewed medical journals. Trial registration: ISRCTN10580502

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