Methods of blood pressure measurement in the ICU.
Methods of blood pressure measurement in the ICU.
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DOI：
10.1097/ccm.0b013e318265ea46
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发表时间：
2013-01
影响因子：
8.8
通讯作者：
Malhotra A
中科院分区：
文献类型：
--
作者：
Lehman LW;Saeed M;Talmor D;Mark R;Malhotra A
最少的临床研究已经调查了ICU中不同血压监测技术的意义，以及在治疗方案和定义临床研究队列时是否应将收缩压与平均血压作为目标。本研究的目的是比较真实世界的有创动脉血压与无创血压，并确定这两种技术之间的差异是否具有临床意义。我们进行了一项回顾性研究，使用大型ICU数据库比较有创动脉血压和无创血压测量。我们对有创动脉血压和无创血压的同时测量值进行了成对比较。我们研究了收缩压、平均有创动脉压和无创血压与急性肾损伤以及ICU死亡率的关系。三级医院的成人重症监护室。2001年至2007年期间入住重症监护室的成年患者。没有。对27，022对同时测量的有创动脉血压/无创血压对进行的成对分析表明，在低血压期间，无创血压高估了收缩期有创动脉血压。急性肾损伤和ICU死亡率的分析分别涉及1，633和4，957例患者。我们的研究结果表明，在相同范围内（≤70 mm Hg），与有创收缩压相比，无创收缩压读数过高与急性肾损伤患病率（p = 0.008）和ICU死亡率（p < 0.001）相关。无创血压和有创动脉血压平均动脉压显示出更好的一致性;与过度平均动脉压读数（≤60 mm Hg）相关的急性肾损伤患病率（p = 0.28）和ICU死亡率（p = 0.76）与测量技术无关。在低血压期间，有创和无创收缩压测量之间存在临床显著差异。在评估患者预后时，两种技术的平均血压可以以一致的方式进行解释。我们的研究结果表明，平均血压而不是收缩压是ICU指导治疗的首选指标。(Crit Care Med 2013;41：0-0）
Minimal clinical research has investigated the significance of different blood pressure monitoring techniques in the ICU and whether systolic vs. mean blood pressures should be targeted in therapeutic protocols and in defining clinical study cohorts. The objectives of this study are to compare real-world invasive arterial blood pressure with noninvasive blood pressure, and to determine if differences between the two techniques have clinical implications. We conducted a retrospective study comparing invasive arterial blood pressure and noninvasive blood pressure measurements using a large ICU database. We performed pairwise comparison between concurrent measures of invasive arterial blood pressure and noninvasive blood pressure. We studied the association of systolic and mean invasive arterial blood pressure and noninvasive blood pressure with acute kidney injury, and with ICU mortality. Adult intensive care units at a tertiary care hospital. Adult patients admitted to intensive care units between 2001 and 2007. None. Pairwise analysis of 27,022 simultaneously measured invasive arterial blood pressure/noninvasive blood pressure pairs indicated that noninvasive blood pressure overestimated systolic invasive arterial blood pressure during hypotension. Analysis of acute kidney injury and ICU mortality involved 1,633 and 4,957 patients, respectively. Our results indicated that hypotensive systolic noninvasive blood pressure readings were associated with a higher acute kidney injury prevalence (p = 0.008) and ICU mortality (p < 0.001) than systolic invasive arterial blood pressure in the same range (≤70 mm Hg). Noninvasive blood pressure and invasive arterial blood pressure mean arterial pressures showed better agreement; acute kidney injury prevalence (p = 0.28) and ICU mortality (p = 0.76) associated with hypotensive mean arterial pressure readings (≤60 mm Hg) were independent of measurement technique. Clinically significant discrepancies exist between invasive and noninvasive systolic blood pressure measurements during hypotension. Mean blood pressure from both techniques may be interpreted in a consistent manner in assessing patients’ prognosis. Our results suggest that mean rather than systolic blood pressure is the preferred metric in the ICU to guide therapy. (Crit Care Med 2013;41:0–0)