Temporal changes in blood pressure following prehospital rapid sequence intubation

BackgroundRapid Sequence intubation (RSI) is an airway procedure that uses sedative and paralytic drugs to facilitate endotracheal intubation. It is known that RSI could impact blood pressure in the peri-intubation period. However, little is known about blood pressure changes in longer time frames. Therefore, this analysis aims to describe the changes in systolic blood pressure in a large cohort of paramedic-led RSI cases over the whole prehospital timespan.MethodsIntensive Care Paramedics in Victoria, Australia, are authorised to use RSI in medical or trauma patients with a Glasgow Coma Scale <10. This retrospective cohort study analysed data from patientcare records for patients aged 12 years and above that had received RSI, from 1 January 2008 to 31 December 2019. This study quantifies the systolic blood pressure changes using regression with fractional polynomial terms. The analysis is further stratified by high versus Low Shock Index (LSI). The shock index is calculated by dividing pulse rate by systolic blood pressure.ResultsDuring the study period RSI was used in 8613 patients. The median number of blood pressure measurements was 5 (IQR 3–8). Systolic blood pressure rose significantly by 3.4 mm Hg (p<0.001) and then returned to baseline in the first 5 min after intubation for LSI cases. No initial rise in blood pressure is apparent in High Shock Index (HSI) cases. Across the whole cohort, systolic blood pressure decreased by 7.1 mm Hg (95% CI 7.9 to 6.3 mm Hg; p<0.001) from the first to the last blood pressure measured.ConclusionsOur study shows that in RSI patients a small transient elevation in systolic blood pressure in the immediate postintubation period is found in LSI, but this elevation is not apparent in HSI. Blood pressure decreased over the prehospital phase in RSI patients with LSI, but increased for HSI cases.

Download Full-text

The association of ketamine induction with blood pressure changes in paramedic rapid sequence intubation of out‐of‐hospital traumatic brain injury

Academic Emergency Medicine ◽

10.1111/acem.14256 ◽

2021 ◽

Author(s):

Pieter F. Fouche ◽

Ben Meadley ◽

Toby St Clair ◽

Alison Winnall ◽

Paul A. Jennings ◽

...

Keyword(s):

Blood Pressure ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Rapid Sequence Intubation ◽

Rapid Sequence ◽

Pressure Changes

Download Full-text

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

10.21203/rs.3.rs-33779/v2 ◽

2020 ◽

Author(s):

Se Jin Park ◽

Mi Jin Lee ◽

Changho Kim ◽

Haewon Jung ◽

Seong Hun Kim ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Logistic Regression ◽

Systolic Blood Pressure ◽

Massive Transfusion ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Shock Index ◽

Cutoff Value ◽

The Impact

Abstract Background: Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age and antihypertensives. Methods: This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. A multivariable logistic regression analysis was conducted to estimate the association of age and antihypertensives on primary and secondary outcomes. Results: We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 hypertensive patients (29.4%). MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, a prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for predicting MT in patients who were older than 65 years and were not taking antihypertensives. Conclusions: The triage of trauma patients is based on the identification of clinical features readily identifiable by first responders. However, age and medications may also affect the accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

Download Full-text

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

10.21203/rs.3.rs-33779/v1 ◽

2020 ◽

Author(s):

Se Jin Park ◽

Mi Jin Lee ◽

Changho Kim ◽

Haewon Jung ◽

Seong Hun Kim ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Systolic Blood Pressure ◽

Massive Transfusion ◽

Geriatric Trauma ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Shock Index ◽

Cutoff Value ◽

The Impact

Abstract Background : Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age or antihypertensives. Methods : This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. Results : We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 (29.4%) hypertensive patients. MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for the prediction of MT in patients who were older than 65 years who were not taking antihypertensives. Conclusions : The triage of trauma patients is based on the identification of clinical features that are readily identifiable by first responders. However, age and medications may also affect accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

Download Full-text

Association of blood pressure changes with survival after paramedic rapid sequence intubation in out‐of‐hospital patients with stroke

Emergency Medicine Australasia ◽

10.1111/1742-6723.13594 ◽

2020 ◽

Author(s):

Pieter F Fouche ◽

Paul A Jennings ◽

Malcolm Boyle ◽

Stephen Bernard ◽

Karen Smith

Keyword(s):

Blood Pressure ◽

Rapid Sequence Intubation ◽

Rapid Sequence ◽

Hospital Patients ◽

Pressure Changes

Download Full-text

The impact of age and receipt antihypertensives to systolic blood pressure and shock index at injury scene and in the emergency department to predict massive transfusion in trauma patients

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00840-2 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Se Jin Park ◽

Mi Jin Lee ◽

Changho Kim ◽

Haewon Jung ◽

Seong Hun Kim ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Logistic Regression ◽

Systolic Blood Pressure ◽

Massive Transfusion ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Shock Index ◽

Cutoff Value ◽

The Impact

Abstract Background Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age and antihypertensives. Methods This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. A multivariable logistic regression analysis was conducted to estimate the association of age and antihypertensives on primary and secondary outcomes. Results We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 hypertensive patients (29.4%). MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, a prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for predicting MT in patients who were older than 65 years and were not taking antihypertensives. Conclusions The triage of trauma patients is based on the identification of clinical features readily identifiable by first responders. However, age and medications may also affect the accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

Download Full-text

Comparison of Ketamine and Etomidate During Rapid Sequence Intubation in Trauma Patients

Case Medical Research ◽

10.31525/ct1-nct04120870 ◽

2019 ◽

Author(s):

Keyword(s):

Rapid Sequence Intubation ◽

Trauma Patients ◽

Rapid Sequence

Download Full-text

Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01586-9 ◽

2021 ◽

Author(s):

David T. McGreevy ◽

Mitra Sadeghi ◽

Kristofer F. Nilsson ◽

Tal M. Hörer

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Hemodynamic Instability ◽

Balloon Occlusion ◽

University Hospital ◽

Trauma Patients ◽

Single Center ◽

Hemorrhage Control ◽

Single Center Experience ◽

Low Profile

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

Download Full-text

Systolic blood pressure below 110mmHg is associated with increased mortality in penetrating major trauma patients: Multicentre cohort study

Resuscitation ◽

10.1016/j.resuscitation.2011.10.018 ◽

2012 ◽

Vol 83 (4) ◽

pp. 476-481 ◽

Cited By ~ 54

Author(s):

Rebecca M. Hasler ◽

Eveline Nüesch ◽

Peter Jüni ◽

Omar Bouamra ◽

Aristomenis K. Exadaktylos ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Systolic Blood Pressure ◽

Major Trauma ◽

Trauma Patients ◽

Multicentre Cohort Study ◽

Multicentre Cohort

Download Full-text

Association between ibrutinib treatment and hypertension

Heart ◽

10.1136/heartjnl-2021-319110 ◽

2021 ◽

pp. heartjnl-2021-319110

Author(s):

Dae Hyun Lee ◽

Fahad Hawk ◽

Kieun Seok ◽

Matthew Gliksman ◽

Josephine Emole ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Repeated Measures ◽

Treatment Initiation ◽

Kinase Inhibitor ◽

Pressure Change ◽

Exact Test ◽

N 93 ◽

Pressure Changes ◽

Over Time

BackgroundIbrutinib is a tyrosine kinase inhibitor most commonly associated with atrial fibrillation. However, additional cardiotoxicities have been identified, including accelerated hypertension. The incidence and risk factors of new or worsening hypertension following ibrutinib treatment are not as well known.MethodsWe conducted a retrospective study of 144 patients diagnosed with B cell malignancies treated with ibrutinib (n=93) versus conventional chemoimmunotherapy (n=51) and evaluated their effects on blood pressure at 1, 2, 3 and 6 months after treatment initiation. Descriptive statistics were used to compare baseline characteristics for each treatment group. Fisher’s exact test was used to identify covariates significantly associated with the development of hypertension. Repeated measures analyses were conducted to analyse longitudinal blood pressure changes.ResultsBoth treatments had similar prevalence of baseline hypertension at 63.4% and 66.7%, respectively. There were no differences between treatments by age, sex and baseline cardiac comorbidities. Both systolic and diastolic blood pressure significantly increased over time with ibrutinib compared with baseline, whereas conventional chemoimmunotherapy was not associated with significant changes in blood pressure. Baseline hypertensive status did not affect the degree of blood pressure change over time. A significant increase in systolic blood pressure (defined as more than 10 mm Hg) was noted for ibrutinib (36.6%) compared with conventional chemoimmunotherapy (7.9%) at 1 month after treatment initiation. Despite being hypertensive at follow-up, 61.2% of patients who were treated with ibrutinib did not receive adequate blood pressure management (increase or addition of blood pressure medications). Within the ibrutinib group, of patients who developed more than 20 mm Hg increase in systolic blood pressure, only 52.9% had hypertension management changes.ConclusionsIbrutinib is associated with the development of hypertension and worsening of blood pressure. Cardiologists and oncologists must be aware of this cardiotoxicity to allow timely management of blood pressure elevations.

Download Full-text