Defining Hypotension in Moderate to Severely Injured Trauma Patients: Raising the Bar for the Elderly

2010 ◽  
Vol 76 (10) ◽  
pp. 1035-1038 ◽  
Author(s):  
Meghan Edwards ◽  
Eric Ley ◽  
James Mirocha ◽  
Anoushiravan Amini Hadjibashi ◽  
Daniel R. Margulies ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Los Angeles ◽  
Systolic Blood Pressure ◽  
Hemorrhagic Shock ◽  
Head Injuries ◽  
Age Groups ◽  
The Elderly ◽  
Trauma Patients ◽  
Severely Injured ◽  
Definition Of

Hypotension, defined as systolic blood pressure less than 90 mm Hg, is recognized as a sign of hemorrhagic shock and is a validated prognostic indicator. The definition of hypotension, particularly in the elderly population, deserves attention. We hypothesized that the systolic blood pressure associated with increased mortality resulting from hemorrhagic shock increases with increasing age. The Los Angeles County Trauma Database was queried for all moderate to severely injured patients without major head injuries admitted between 1998 and 2005. Several fit statistic analyses were performed for each systolic blood pressure from 50 to 180 mm Hg to identify the model that most accurately defined hypotension for three age groups. The optimal definition of hypotension for each group was determined from the best fit model. A total of 24,438 patients were analyzed. The optimal definition of hypotension was systolic blood pressure of 100 mm Hg for patients 20 to 49 years, 120 mm Hg for patients 50 to 69 years, and 140 mm Hg for patients 70 years and older. The optimal systolic blood pressure for improved mortality in hemorrhagic shock increases significantly with increasing age. Elderly trauma patients without major head injuries should be considered hypotensive for systolic blood pressure less than 140 mm Hg.

P5728Association of systolic blood pressure and cardiovascular outcomes at different age groups in the healthy general population: a nationwide prospective cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M H Jung ◽  
S H Ihm ◽  
S J An ◽  
S W Yi
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Age Groups ◽  
The Elderly ◽  
Cardiovascular Outcomes ◽  
Stroke Mortality ◽  
Linear Association ◽  
Hazard Ratios ◽  
Individualized Approach ◽  
Cvd Mortality

Abstract Background Uncertainties remain regarding the effect of blood pressure on various cardiovascular outcomes in different age groups. Purpose We aimed to identify 1) whether a systolic blood pressure (SBP) of 130–139 mm Hg elevates cardiovascular disease (CVD) mortality and 2) whether SBP shows a linear association with cause-specific CVD mortality in all age groups among individuals without known hypertension and CVD. Methods We used the Korean National Health Insurance sample data (n=429,220). Participants were categorized into three groups by age (40–59, 60–69, and 70–80 years). Results A positive and graded association was generally observed between SBP and overall and cause-specific CVD mortality regardless of age, except for ischemic heart disease (IHD) mortality in those aged 70–80 years. Among those aged 70–80, the hazard ratios (HRs) (95% CIs) for overall CVD mortality were 1.08 (0.92–1.28), 1.14 (0.97–1.34), and 1.34 (1.14–1.58) for SBP values of 120–129, 130–139, and 140–149 mm Hg, respectively, compared to SBP <120 mm Hg. For total stroke mortality, the corresponding HRs were 1.29 (1.02–1.64), 1.37 (1.09–1.72), and 1.52 (1.20–1.93), while for IHD mortality, the corresponding HRs were 0.90 (0.64–1.26), 0.86 (0.62–1.19), and 1.29 (0.93–1.78). Nonlinear associations were significant for IHD (Fig 1). Figure 1 Conclusion In the elderly Korean population, SBPs of 130–139 mm Hg elevated total stroke mortality, but not IHD mortality, compared to normal BP, and a linear association was not observed for IHD mortality in the range <140 mm Hg. Regarding an appropriate diagnostic cutoff for hypertension, an individualized approach considering each person's organ susceptibility is needed for the elderly population. Acknowledgement/Funding None

scholarly journals Age-specific associations between systolic blood pressure and cardiovascular mortality

Heart ◽  
2019 ◽  
Vol 105 (14) ◽  
pp. 1070-1077 ◽  
Author(s):  
Mi-Hyang Jung ◽  
Sang-Wook Yi ◽  
Sang Joon An ◽  
Jee-Jeon Yi
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Age Groups ◽  
The Elderly ◽  
Stroke Mortality ◽  
Linear Association ◽  
Sample Data ◽  
Korean National Health Insurance ◽  
Cvd Mortality

ObjectiveWe aimed to identify the following in all age groups among individuals without known hypertension and CVD: (1) Whether a systolic blood pressure (SBP) of 130–139 mm Hg elevates cardiovascular disease (CVD) mortality. (2) Whether SBP shows a linear association with cause-specific CVD mortality.MethodsWe used the Korean National Health Insurance sample data (n=429 220). Participants were categorised into three groups by age (40–59 years, 60–69 years and 70–80 years).ResultsDuring 10.4 years of follow-up, 4319 cardiovascular deaths occurred. A positive and graded association was generally observed between SBP and overall and cause-specific CVD mortality regardless of age, except for ischaemic heart disease (IHD) mortality in those aged 70–80 years. Among those aged 70–80 years, the HRs (95% CIs) for overall CVD mortality were 1.08 (0.92–1.28), 1.14 (0.97–1.34) and 1.34 (1.14–1.58) for SBP values of 120–129 mm Hg, 130–139 mm Hg and 140–149 mm Hg, respectively, compared with SBP <120 mm Hg. For total stroke mortality, the corresponding HRs were 1.29 (1.02–1.64), 1.37 (1.09–1.72) and 1.52 (1.20–1.93), while for IHD mortality, the corresponding HRs were 0.90 (0.64–1.26), 0.86 (0.62–1.19) and 1.29 (0.93–1.78), respectively. Non-linear associations were significant for IHD.ConclusionsIn the elderly Korean population, SBPs of 130–139 mm Hg elevated total stroke mortality, but not IHD mortality, compared with normal blood pressure, and a linear association was not observed for IHD mortality in the range <140 mm Hg.

The critical threshold value of systolic blood pressure for aortic occlusion in trauma patients in profound hemorrhagic shock

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Carlos A. Ordoñez ◽  
Fernando Rodríguez ◽  
Claudia P. Orlas ◽  
Michael W. Parra ◽  
Yaset Caicedo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Hemorrhagic Shock ◽  
Threshold Value ◽  
Aortic Occlusion ◽  
Critical Threshold ◽  
Trauma Patients

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

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.

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

Resuscitation ◽  
2012 ◽  
Vol 83 (4) ◽  
pp. 476-481 ◽  
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

Ambulatory Blood Pressure Recordings in Children and Adolescents

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 180-184
Author(s):  
Gregory A. Harshfield ◽  
Bruce S. Alpert ◽  
Derrick A. Pulliam ◽  
Grant W. Somes ◽  
Dawn K. Wilson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Reference Data ◽  
Blood Pressure Monitoring ◽  
Age Groups ◽  
Specific Reference ◽  
Pressure Monitoring ◽  
Black And White

Objective. To provide reference data for ambulatory blood pressure monitoring (ABPM) and to determine the influence of age, sex, and race on these values. Methods. ABPM was performed on 300 healthy, normotensive boys and girls between the ages of 10 and 18 years, including 160 boys and 140 girls, of whom 149 were white and 151 were black. Mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) while awake and during sleep were calculated for black and white boys and girls aged 10 to 12 years, 13 to 15 years, and 16 to 18 years. Results. Boys compared with girls 10 to 12 years of age had higher mean (±SD) SBP (115 ± 9 vs 112 ± 9 mm Hg; P &lt; .01) and DBP (67 ± 7 vs 65 ± 5 mm Hg; P &lt; .01) while awake. Boys compared to girls 13 to 15 years of age had higher SBP while awake (116 ± 11 vs 112 ± 8 mm Hg; P &lt; .01). Boys compared with girls 16 to 18 years of age had higher SBP while awake (125 ± 12 vs 111 ± 9 mm Hg; P &lt; .01) and during sleep (116 ± 11 vs 106 ± 9 mm Hg). Comparisons within sex showed similar changes with age for boys and girls. Blacks compared with whites 13 to 15 years of age had higher SBP during sleep (109 ± 11 vs 105 ± 10 mm Hg; P &lt; .01), and blacks compared with whites 16 to 18 years of age had higher DBP during sleep (66 ± 7 vs 58 ± 6 mm Hg; P &lt; .01). Comparisons across age groups within race showed that blacks 16 to 18 years of age had higher SBP during sleep than blacks 10 to 12 years of age (109 ± 11 vs 104 ± 10 mm Hg), and higher DBP during sleep (66 ± 7 mm Hg; P &lt; .01) than blacks 10 to 12 years of age (61 ± 7 mm Hg; P &lt; .01) and 13 to 15 years of age (61 ± 8; P &lt; .01 mm Hg). The changes with age were not significant for white subjects. Conclusion. These results provide age-specific reference data for ABPM in youths. These values differ by sex (boys more than girls) and race (Blacks more than Whites).

The Prevalence of Dementia in the Elderly: A Review

1994 ◽  
Vol 39 (5) ◽  
pp. 253-257 ◽  
Author(s):  
Kenneth Rockwood ◽  
Karen Stadnyk
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Age Groups ◽  
The Elderly ◽  
Community Studies ◽  
Prevalence Studies ◽  
Clinical Interviews ◽  
Dementia Prevalence ◽  
History Of ◽  
Definition Of

We reviewed the findings of the Canadian Study of Health and Aging in the context of studies published between January 1986 and June 1993 that documented dementia and Alzheimer's disease prevalence. Studies were identified using a MEDLINE literature search. Additional references were selected from the bibliography of identified articles. Most reports of all types of dementia prevalence are within a narrow range for each of the age groups 65+, 75+ and 85+ years. By contrast, two recent reports on the prevalence of Alzheimer's disease have reported much higher estimates (10.3% and 15.3%) in the elderly (65+ years). A variety of threats to both validity and generalizability of the estimates are present in all studies. In community studies which employed clinical interviews most subjects were only mildly affected; the natural history of impairment of this group requires further study if the consequences of these findings are to be understood. There is important variability in the definition of the functional consequences of cognitive impairment in the elderly which affects both the diagnosis and staging of dementia.

scholarly journals Ten-year survival of Finnish lower limb amputees

1998 ◽  
Vol 22 (1) ◽  
pp. 10-16 ◽  
Author(s):  
T. Pohjolainen ◽  
H. Alaranta
Keyword(s):  
Median Survival ◽  
Lower Limb ◽  
Social Insurance ◽  
Age Groups ◽  
Vascular Diseases ◽  
The Elderly ◽  
Limb Amputation ◽  
Diabetic Patients ◽  
Trauma Patients ◽  
One Year

Data on mortality for the ten years following lower limb amputation were obtained from all the 16 surgical units in Southern Finland and the National Social Insurance Institution. In Southern Finland during the period 1984-1985, amputations of the lower limb were performed on 705 patients, of whom 382 (54%) were women and 323 (46%) men. The majority of the amputations, 47%, were performed for vascular diseases and 41% were performed for diabetes mellitus. The overall survival was 62% at one year after amputation, 49% at two years, 27% at five years and 15% at ten years. The median survival after amputation was 1 yr 5 mth for the women and 2 yr 8 mth for the men. Of the arteriosclerotics, 43% died within one postoperative year while 43% lived longer than two years and 23% longer than five years. The median survival of arteriosclerotics was 1 yr 6 mth. The corresponding figure for patients with diabetes was 1 yr 11 mth. Of the diabetics, 38% died within one postoperative year while 47% lived longer than two years and 20% longer than five years. Of the trauma patients, 86% lived longer than five years and 71% longer than ten years. Of the trans-femoral amputees, 54% lived longer than one year, 36% over two years, 18% over five years and 8% over ten years. The corresponding figures for trans-tibial amputees were 70%. 53%, 21% and 4%. Many elderly vascular and diabetic patients undergoing amputation have a reduced physiological reserve and high mortality. The more proximal the amputation, the greater the risk that the patient will never be able to walk or that the duration of use of the prosthesis will be short. If a prosthesis seems to be a reasonable option for the elderly amputee, any delays in prosthetic fitting should be avoided in older age groups.

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