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

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.

scholarly journals Defining human mean circulatory filling pressure in the intensive care unit

2020 ◽  
Vol 129 (2) ◽  
pp. 311-316
Author(s):  
Marije Wijnberge ◽  
Jaap Schuurmans ◽  
Rob B. P. de Wilde ◽  
Martijn K. Kerstens ◽  
Alexander P. Vlaar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Pressure ◽  
Filling Pressure ◽  
Central Venous ◽  
Venous Compliance ◽  
Icu Patients ◽  
Mean Circulatory Filling Pressure ◽  
Arterial Blood

In a cohort of 311 intensive care unit (ICU) patients, median mean circulatory filling pressure (Pmcf) measured after cardiac arrest was 15 mmHg (interquartile range 12–18). In 48% of cases, arterial blood pressure remained higher than central venous pressure, but correction for arterial-to-venous compliance differences did not result in clinically relevant alterations of Pmcf. Fluid balance, use of vasopressors or inotropes, and being on mechanical ventilation were associated with a higher Pmcf.

scholarly journals Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery

2020 ◽  
Vol 133 (5) ◽  
pp. 997-1006 ◽  
Author(s):  
Josef Briegel ◽  
Torsten Bähner ◽  
Alois Kreitmeier ◽  
Philippe Conter ◽  
Luca Fraccaroli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Noncardiac Surgery ◽  
High Fidelity ◽  
Pressure Measurements ◽  
Upper Arm ◽  
Arterial Blood ◽  
Accuracy And Precision ◽  
Severe Hypotension

Background In most patients having noncardiac surgery, blood pressure is measured with the oscillometric upper arm cuff method. Although the method is noninvasive and practical, it is known to overestimate intraarterial pressure in hypotension and to underestimate it in hypertension. A high-fidelity upper arm cuff incorporating a hydraulic sensor pad was recently developed. The aim of the present study was to investigate whether noninvasive blood pressure measurements with the new high-fidelity cuff correspond to invasive measurements with a femoral artery catheter, especially at low blood pressure. Methods Simultaneous measurements of blood pressure recorded from a femoral arterial catheter and from the high-fidelity upper arm cuff were compared in 110 patients having major abdominal surgery or neurosurgery. Results 550 pairs of blood pressure measurements (5 pairs per patient) were considered for analysis. For mean arterial pressure measurements, the average bias was 0 mmHg, and the precision was 3 mmHg. The Pearson correlation coefficient was 0.96 (P < 0.0001; 95% CI, 0.96 to 0.97), and the percentage error was 9%. Error grid analysis showed that the proportions of mean arterial pressure measurements done with the high-fidelity cuff method were 98.4% in zone A (no risk), 1.6% in zone B (low risk) and 0% in zones C, D, and E (moderate, significant, and dangerous risk, respectively). The high-fidelity cuff method detected mean arterial pressure values less than 65 mmHg with a sensitivity of 84% (95% CI, 74 to 92%) and a specificity of 97% (95% CI, 95% to 98%). To detect changes in mean arterial pressure of more than 5 mmHg, the concordance rate between the two methods was 99.7%. Comparable accuracy and precision were observed for systolic and diastolic blood pressure measurements. Conclusions The new high-fidelity upper arm cuff method met the current international standards in terms of accuracy and precision. It was also very accurate to track changes in blood pressure and reliably detect severe hypotension during noncardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Plasticity in breathing and arterial blood pressure following acute intermittent hypercapnic hypoxia in infant rat pups with a partial loss of 5-HT neurons

2015 ◽  
Vol 309 (10) ◽  
pp. R1273-R1284 ◽  
Author(s):  
Jennifer Magnusson ◽  
Kevin J. Cummings
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Arterial Blood Pressure ◽  
Cardiovascular Responses ◽  
Partial Loss ◽  
Rat Pups ◽  
Arterial Blood ◽  
Hypercapnic Hypoxia ◽  
Long Term Facilitation

The role of serotonin (5-HT) neurons in cardiovascular responses to acute intermittent hypoxia (AIH) has not been studied in the neonatal period. We hypothesized that a partial loss of 5-HT neurons would reduce arterial blood pressure (BP) at rest, increase the fall in BP during hypoxia, and reduce the long-term facilitation of breathing (vLTF) and BP following AIH. We exposed 2-wk-old, 5,7-dihydroxytryptamine-treated and controls to AIH (10% O2; n = 13 control, 14 treated), acute intermittent hypercapnia (5% CO2; n = 12 and 11), or acute intermittent hypercapnic hypoxia (AIHH; 10% O2, 5% CO2; n = 15 and 17). We gave five 5-min challenges of AIH and acute intermittent hypercapnia, and twenty ∼20-s challenges of AIHH to mimic sleep apnea. Systolic BP (sBP), diastolic BP, mean arterial pressure, heart rate (HR), ventilation (V̇e), and metabolic rate (V̇o2) were continuously monitored. 5,7-Dihydroxytryptamine induced an ∼35% loss of 5-HT neurons from the medullary raphe. Compared with controls, pups deficient in 5-HT neurons had reduced resting sBP (∼6 mmHg), mean arterial pressure (∼5 mmHg), and HR (56 beats/min), and experienced a reduced drop in BP during hypoxia. AIHH induced vLTF in both groups, reflected in increased V̇e and V̇e/V̇o2, and decreased arterial Pco2. The sBP of pups deficient in 5-HT neurons, but not controls, was increased 1 h following AIHH. Our data suggest that a relatively small loss of 5-HT neurons compromises resting BP and HR, but has no influence on ventilatory plasticity induced by AIHH. AIHH may be useful for reversing cardiorespiratory defects related to partial 5-HT system dysfunction.

Increased vascular resistance in paralyzed legs after spinal cord injury is reversible by training

2002 ◽  
Vol 93 (6) ◽  
pp. 1966-1972 ◽  
Author(s):  
Maria T. E. Hopman ◽  
Jan T. Groothuis ◽  
Marcel Flendrie ◽  
Karin H. L. Gerrits ◽  
Sibrand Houtman
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Blood Flow ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Vascular Resistance ◽  
Arterial Blood Flow ◽  
Arterial Blood ◽  
Cord Injury

The purpose of the present study was to determine the effect of a spinal cord injury (SCI) on resting vascular resistance in paralyzed legs in humans. To accomplish this goal, we measured blood pressure and resting flow above and below the lesion (by using venous occlusion plethysmography) in 11 patients with SCI and in 10 healthy controls (C). Relative vascular resistance was calculated as mean arterial pressure in millimeters of mercury divided by the arterial blood flow in milliliters per minute per 100 milliliters of tissue. Arterial blood flow in the sympathetically deprived and paralyzed legs of SCI was significantly lower than leg blood flow in C. Because mean arterial pressure showed no differences between both groups, leg vascular resistance in SCI was significantly higher than in C. Within the SCI group, arterial blood flow was significantly higher and vascular resistance significantly lower in the arms than in the legs. To distinguish between the effect of loss of central neural control vs. deconditioning, a group of nine SCI patients was trained for 6 wk and showed a 30% increase in leg blood flow with unchanged blood pressure levels, indicating a marked reduction in vascular resistance. In conclusion, vascular resistance is increased in the paralyzed legs of individuals with SCI and is reversible by training.

Increases in intramuscular pressure raise arterial blood pressure during dynamic exercise

2001 ◽  
Vol 91 (5) ◽  
pp. 2351-2358 ◽  
Author(s):  
K. M. Gallagher ◽  
P. J. Fadel ◽  
S. A. Smith ◽  
K. H. Norton ◽  
R. G. Querry ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Arterial Blood Pressure ◽  
Dynamic Exercise ◽  
Positive Pressure ◽  
Intramuscular Pressure ◽  
Arterial Blood ◽  
Exercise In Humans ◽  
Cuff Occlusion

This investigation was designed to determine the role of intramuscular pressure-sensitive mechanoreceptors and chemically sensitive metaboreceptors in affecting the blood pressure response to dynamic exercise in humans. Sixteen subjects performed incremental (20 W/min) cycle exercise to fatigue under four conditions: control, exercise with thigh cuff occlusion of 90 Torr (Cuff occlusion), exercise with lower body positive pressure (LBPP) of 45 Torr, and a combination of thigh cuff occlusion and LBPP (combination). Indexes of central command (heart rate, oxygen uptake, ratings of perceived exertion, and electromyographic activity), cardiac output, stroke volume, and total peripheral resistance were not significantly different between the four conditions. Mechanical stimulation during LBPP and combination conditions resulted in significant elevations in intramuscular pressure and mean arterial pressure from control at rest and throughout the incremental exercise protocol ( P < 0.05). Conversely, there existed no significant changes in mean arterial pressure when the metaboreflex was stimulated by cuff occlusion. These findings suggest that under normal conditions the mechanoreflex is tonically active and is the primary mediator of exercise pressor reflex-induced alterations in arterial blood pressure during submaximal dynamic exercise in humans.

scholarly journals Comparative study of intravenous hydralazine and labetalol in severe hypertensive disorders of pregnancy

2020 ◽  
Vol 9 (2) ◽  
pp. 675
Author(s):  
Anupma Kumari ◽  
Renu Rohatgi ◽  
Amrita Singh ◽  
Raj Kumar
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Neonatal Morbidity ◽  
Medical Complications ◽  
Age Group ◽  
Efficacy And Safety ◽  
Hypertensive Disorders Of Pregnancy ◽  
Arterial Blood ◽  
Hypertensive Disorders

Background: Hypertensive disorders of pregnancy are among the most common medical complications of pregnancy and major cause of maternal, fetal and neonatal morbidity and mortality. The purpose of this study was to compare the efficacy and safety of intravenous hydralazine and labetalol for management of severe hypertensive disorders of pregnancy.Methods: This prospective study was conducted among 100 women admitted with SBP ≥ 160 or DBP ≥ 110 mmHg or both. Patients were divided into 2 groups randomly: labetalol and hydralazine group.Results: Majority of patients (38%) were in the age group of 21-25 years and primigravida (52%). There was more significant decrease in the systolic, diastolic and mean arterial blood pressure at the end of 15 and 30 minutes in labetalol group. Labetalol required fewer doses as compared to hydralazine to achieve the target blood pressure (average 1.95 versus 3.1). Total numbers of term deliveries were 19 (38%) in hydralazine group and 16 (32%) in labetalol group. Pre-term deliveries in hydralazine and labetalol group were 14 (28%) and 15 (30%) respectively. Headache was significantly more common in hydralazine treated patients than labetalol group.Conclusions: Both hydralazine and labetalol were effective and well-tolerated in the treatment of severe hypertensive disorders of pregnancy. Labetalol may be preferred because it was more effective in lowering the systolic blood pressure, diastolic blood pressure and mean arterial pressure to achieve target levels with less number of doses.

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