Discrepancy Between Invasive and Noninvasive Blood Pressure Measurements in Patients with Sepsis by Vasopressor Status.
AuthorTran, Quincy K
Haase, Daniel J
JournalWestern Journal of Emergency Medicine
PublisherUniversity of California Press
MetadataShow full item record
AbstractWest J Emerg Med. 2022 May 5;23(3):358-367. doi: 10.5811/westjem.2022.1.53211. ABSTRACT INTRODUCTION: Blood pressure (BP) monitoring is an essential component of sepsis management. The Surviving Sepsis Guidelines recommend invasive arterial BP (IABP) monitoring, although the benefits over non-invasive BP (NIBP) monitoring are unclear. This study investigated discrepancies between IABP and NIBP measurement and their clinical significance. We hypothesized that IABP monitoring would be associated with changes in management among patients with sepsis requiring vasopressors. METHODS: We performed a retrospective study of adult patients admitted to the critical care resuscitation unit at a quaternary medical center between January 1-December 31, 2017. We included patients with sepsis conditions AND IABP monitoring. We defined a clinically significant BP discrepancy (BPD) between NIBP and IABP measurement as a difference of > 10 millimeters of mercury (mm Hg) AND change of BP management to maintain mean arterial pressure ≥ 65 mm Hg. RESULTS: We analyzed 127 patients. Among 57 (45%) requiring vasopressors, 9 (16%) patients had a clinically significant BPD vs 2 patients (3% odds ratio [OR] 6.4; 95% CI: 1.2-30; P = 0.01) without vasopressors. In multivariable logistic regression, higher Sequential Organ Failure Assessment (SOFA) score (OR 1.33; 95% CI: 1.02-1.73; P = 0.03) and serum lactate (OR 1.27; 95% CI: 1.003-1.60, P = 0.04) were associated with increased likelihood of clinically significant BPD. There were no complications (95% CI: 0-0.02) from arterial catheter insertions. CONCLUSION: Among our population of septic patients, the use of vasopressors was associated with increased odds of a clinically significant blood pressure discrepancy between IABP and NIBP measurement. Additionally, higher SOFA score and serum lactate were associated with higher likelihood of clinically significant blood pressure discrepancy. Further studies are needed to confirm our observations and investigate the benefits vs the risk of harm of IABP monitoring in patients with sepsis.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/19128
- Arterial or cuff pressure: Clinical predictors among patients in shock in a critical care resuscitation unit.
- Authors: Keville MP, Gelmann D, Hollis G, Beher R, Raffman A, Tanveer S, Jones K, Parker BM, Haase DJ, Tran QK
- Issue date: 2021 Aug
- Predictors of clinically relevant differences between noninvasive versus arterial blood pressure.
- Authors: Raffman A, Shah U, Barr JF, Hassan S, Azike LU, Tanveer S, Bracklow S, Parker B, Haase DJ, Tran QK
- Issue date: 2021 May
- Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
- Authors: Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M, Sepsis Definitions Task Force.
- Issue date: 2016 Feb 23
- Arterial Pressure Monitoring in Pediatric Patients Undergoing Cardiac Surgery: An Observational Study Comparing Invasive and Non-invasive Measurements.
- Authors: Ricci Z, Brogi J, De Filippis S, Caccavelli R, Morlacchi M, Romagnoli S
- Issue date: 2019 Aug
- Arterial blood pressure monitoring in overweight critically ill patients: invasive or noninvasive?
- Authors: Araghi A, Bander JJ, Guzman JA
- Issue date: 2006