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Horiguchi D, Shin S, Pepino JA, Peterson JT, Kehoe IE, Goldstein JN, Lee J, Kwon BK, Hahn JO, Reisner AT. Hypotension During Vasopressor Infusion Occurs in Predictable Clusters: A Multicenter Analysis. J Intensive Care Med 2024; 39:683-692. [PMID: 38282376 DOI: 10.1177/08850666241226893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Background: Published evidence indicates that mean arterial pressure (MAP) below a goal range (hypotension) is associated with worse outcomes, though MAP management failures are common. We sought to characterize hypotension occurrences in ICUs and consider the implications for MAP management. Methods: Retrospective analysis of 3 hospitals' cohorts of adult ICU patients during continuous vasopressor infusion. Two cohorts were general, mixed ICU patients and one was exclusively acute spinal cord injury patients. "Hypotension-clusters" were defined where there were ≥10 min of cumulative hypotension over a 60-min period and "constant hypotension" was ≥10 continuous minutes. Trend analysis was performed (predicting future MAP using 14 min of preceding MAP data) to understand which hypotension-clusters could likely have been predicted by clinician awareness of MAP trends. Results: In cohorts of 155, 66, and 16 ICU stays, respectively, the majority of hypotension occurred within the hypotension-clusters. Failures to keep MAP above the hypotension threshold were notable in the bottom quartiles of each cohort, with hypotension durations of 436, 167, and 468 min, respectively, occurring within hypotension-clusters per day. Mean arterial pressure trend analysis identified most hypotension-clusters before any constant hypotension occurred (81.2%-93.6% sensitivity, range). The positive predictive value of hypotension predictions ranged from 51.4% to 72.9%. Conclusions: Across 3 cohorts, most hypotension occurred in temporal clusters of hypotension that were usually predictable from extrapolation of MAP trends.
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Affiliation(s)
- Daisuke Horiguchi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Nihon Kohden Innovation Center, LLC, Cambridge, MA, USA
| | - Sungtae Shin
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Jeremy A Pepino
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey T Peterson
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Iain E Kehoe
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jarone Lee
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston MA, USA
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Andrew T Reisner
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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Hamilton LD, Binns S, McFann K, Nudell N, Dunn JA. A Direct Assessment of Noninvasive Continuous Blood Pressure Monitoring in the Emergency Department and Intensive Care Unit. J Emerg Nurs 2024:S0099-1767(24)00078-3. [PMID: 38639694 DOI: 10.1016/j.jen.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Noninvasive continuous blood pressure monitoring has the potential to improve patient treatment in the hospital setting. Such noninvasive devices can be applied earlier in the treatment process to empower nurses and clinicians to react more quickly to patient deterioration with the added benefit of eliminating the risks associated with invasive monitoring. However, emerging technologies must be capable of reproducing current clinical measures for medical decision making. METHODS This study aimed to determine the usability and willingness of nurses to implement a noninvasive continuous blood pressure monitoring device. The secondary aim directly compared the systolic blood pressure, diastolic blood pressure, and mean arterial pressure values recorded by the device (VitalStream; CareTaker Medical LLC, Charlottesville, VA) with the "gold standard" brachial cuff and arterial line measures recorded in the emergency department and intensive care unit settings. RESULTS VitalStream was similarly received by nurses in the emergency department and intensive care setting, but ultimately had greater promotion from emergency nurses. Despite some statistical similarity between measurement methodologies, all direct comparisons were found to not meet the Association for the Advancement of Medical Instrumentation 2008 and Association for the Advancement of Medical Instrumentation / European Society of Hypertension / International Organization for Standardization 2019 consensus statement criteria for acceptable blood pressure measure differences between the VitalStream and "gold standard" clinical measures. In all instances, the standard deviation of the Bland-Altman bias exceeded 8 mm Hg with less than 85% of paired differences falling within 10 mm Hg of the "gold standard." DISCUSSION Taken together, the tested device requires additional postprocessing for medical decision making in trauma or emergent care.
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Abdulmelik A, Tila M, Tekilu T, Debalkie A, Habtu E, Sintayehu A, Dendir G, Gordie N, Daniel A, Suleiman Obsa M. Magnitude and associated factors of intraoperative cardiac complications among geriatric patients who undergo non-cardiac surgery at public hospitals in the southern region of Ethiopia: a multi-center cross-sectional study in 2022/2023. Front Med (Lausanne) 2024; 11:1325358. [PMID: 38695033 PMCID: PMC11061426 DOI: 10.3389/fmed.2024.1325358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Background Intraoperative cardiac complications are a common cause of morbidity and mortality in non-cardiac surgery. The risk of these complications increased with the average age increasing from 65. In a resource-limited setting, including our study area, the magnitude and associated factors of intraoperative cardiac complications have not been adequately investigated. The aim of this study was to assess the magnitude and associated factors of intraoperative cardiac complications among geriatric patients undergoing non-cardiac surgery. Methods An institutional-based multi-center cross-sectional study was conducted on 304 geriatric patients at governmental hospitals in the southern region of Ethiopia, from 20 March 2022 to 25 August 2022. Data were collected by chart review and patient interviews. Epi Data version 4.6 and SPSS version 25 were used for analysis. The variables that had association (p < 0.25) were considered for multivariable logistic regression. A p value < 0.05 was considered significant for association. Result The overall prevalence of intraoperative cardiac complications was 24.3%. Preoperative ST-segment elevation adjusted odds ratio (AOR = 2.43, CI =2.06-3.67), history of hypertension (AOR = 3.42, CI =2.02-6.08), intraoperative hypoxia (AOR = 3.5, CI = 2.07-6.23), intraoperative hypotension (AOR = 6.2 9, CI =3.51-10.94), age > 85 years (AOR = 6.01, CI = 5.12-12.21), and anesthesia time > 3 h (AOR =2.27, CI = 2.0.2-18.25) were factors significantly associated with intraoperative cardiac complications. Conclusion The magnitude of intraoperative cardiac complications was high among geriatric patients who had undergone non-cardiac surgery. The independent risk factors of intraoperative cardiac complications for this population included age > 85, ST-segment elevation, perioperative hypertension (stage 3 with regular treatment), duration of anesthesia >3 h, intraoperative hypoxia, and intraoperative hypotension. Holistic preoperative evaluation, optimization optimal and perioperative care for preventing perioperative risk factors listed above, and knowing all possible risk factors are suggested to reduce the occurrence of complications.
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Affiliation(s)
- Amina Abdulmelik
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Mebratu Tila
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Takele Tekilu
- School of Medical Laboratory, College of Medicine and Health Science, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Ashebir Debalkie
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Elias Habtu
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Ashagrie Sintayehu
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Getahun Dendir
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Naol Gordie
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Abel Daniel
- School of Medicine, College of Medicine and Health Science, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Mohammed Suleiman Obsa
- Department of Anesthesia, College of Medicine and Health Science, Arsi University, Assela, Ethiopia
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Jiang Z, Li S, Wang L, Yu F, Zeng Y, Li H, Li J, Zhang Z, Zuo J. A comparison of invasive arterial blood pressure measurement with oscillometric non-invasive blood pressure measurement in patients with sepsis. J Anesth 2024; 38:222-231. [PMID: 38305914 DOI: 10.1007/s00540-023-03304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/25/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE This study aimed to compare non-invasive oscillometric blood pressure (NIBP) measurement with invasive arterial blood pressure (IBP) measurement in patients with sepsis. METHODS We conducted a retrospective study to evaluate the agreement between IBP and NIBP using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Paired blood pressure measurements of mean arterial pressure (MAP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were compared using Bland-Altman analysis and paired Student's t test. We also focus on the effect of norepinephrine (NE) on the agreement between the two methods and the association between blood pressure and mortality during intensive care unit (ICU) stay. RESULTS A total of 96,673 paired blood pressure measurements from 6060 unique patients were analyzed in the study. In Bland-Altman analysis, the bias (± SD, 95% limits of agreement) was 6.21 mmHg (± 12.05 mmHg, - 17.41 to 29.83 mmHg) for MAP, 0.39 mmHg (± 19.25 mmHg, - 37.34 to 38.12 mmHg) for SBP, and 0.80 mmHg (± 12.92 mmHg, - 24.52 to 26.12 mmHg) for DBP between the two techniques. Similarly, large limits of agreement were shown in different groups of NE doses. NE doses significantly affected the agreement between IBP and NIBP. SBP between the two methods gave an inconsistent assessment of patients' risk of ICU mortality. CONCLUSION IBP and NIBP were not interchangeable in septic patients. Clinicians should be aware that non-invasive MAP was clinically and significantly underestimated invasive MAP.
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Affiliation(s)
- Ziqing Jiang
- Candidate of Master's Degree, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Shaoying Li
- Candidate of Master's Degree, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Lin Wang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Feng Yu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Yanping Zeng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Hongbo Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Jun Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Zhanfeng Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Junling Zuo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China.
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Schuurmans J, van Rossem BTB, Rellum SR, Tol JTM, Kurucz VC, van Mourik N, van der Ven WH, Veelo DP, Schenk J, Vlaar APJ. Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis. Intensive Care Med 2024; 50:516-525. [PMID: 38252288 PMCID: PMC11018652 DOI: 10.1007/s00134-023-07304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes. METHODS CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses. RESULTS A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of 'no hypotension' for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12-1.88; based on 13 studies and 34,829 patients), but not for AKI. CONCLUSION Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI.
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Affiliation(s)
- Jaap Schuurmans
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Benthe T B van Rossem
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Santino R Rellum
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johan T M Tol
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Vincent C Kurucz
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Niels van Mourik
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ward H van der Ven
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Denise P Veelo
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Jimmy Schenk
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
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6
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Bijender, Kumar S, Soni A, Yadav R, Singh SP, Kumar A. Noninvasive Blood Pressure Monitoring via a Flexible and Wearable Piezoresistive Sensor. ACS OMEGA 2024; 9:6355-6365. [PMID: 38375497 PMCID: PMC10876045 DOI: 10.1021/acsomega.3c04786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
In the present global context, continuous blood pressure (BP) monitoring is paramount in addressing the global mortality rates attributed to hypertension. Achieving precise insights into the human cardiovascular system necessitates accurate measurement of BP, and the accuracy depends on the faithful recording of oscillations or pulsations. This task ultimately depends on the caliber of the pressure sensor embedded in the BP device. In this context, we have fabricated a flexible resistive pressure sensor based on reduced graphene oxide (rGO) and a polydimethylsiloxane (PDMS) sponge that is highly flexible and sensitive. The designed device operates effectively with a minimal bias voltage of 500 mV, at which point it showed its maximum relative change in current, reaching approximately 25%. Additionally, the sensing device showed a notable change in resistance values, exhibiting almost 100% change in resistance when subjected to a pressure of 400 mmHg and high sensitivity of 0.27 mmHg-1. After promising outcomes were obtained during static pressure measurement, the sensor was used for BP monitoring in humans. The sensor accurately traced the oscillometric waveform (OMW) for distinct systolic blood pressure (SBP) and diastolic blood pressure (DBP) combinations to cover a range of medical situations, including hypotension, standard or normal, and hypertension. The values of SBP, DBP, and MAP were derived from the sensor's output using the MAA technique, and the errors in these values concerning the simulator and the traditional BP monitor follow the universal AAMI/ESH/ISO protocols. Bland-Altman (B&A) correlation and scatter plots were used to compare the sensor's results and further validate the proposed sensor. The sensor showed the mean and standard deviation error in the SBP, DBP, and MBP of -0.2 ± 5.9, -0.5 ± 7, and -0.9 ± 4.7 mmHg when compared with the noninvasive blood pressure (NIBP) simulator. The pulse rate (PR) was also calculated from the same OMW for the specified value of 80 beats per minute (bpm) given by the simulator and reported a mean PR value of ∼81 bpm, close to the reference value. The findings show that the flexible resistive sensing device can accurately measure BP and replace the existing sensors of BP devices.
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Affiliation(s)
- Bijender
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Shubham Kumar
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Amit Soni
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Rimjhim Yadav
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Surinder P. Singh
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Ashok Kumar
- CSIR-National
Physical Laboratory, Dr. K. S. Krishnan
Marg, New Delhi 110012, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
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Kandil S, Sedra A. Hemodynamic monitoring in liver transplantation 'the hemodynamic system'. Curr Opin Organ Transplant 2024; 29:72-81. [PMID: 38032246 DOI: 10.1097/mot.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to provide a comprehensive review of hemodynamic monitoring in liver transplantation. RECENT FINDINGS Radial arterial blood pressure monitoring underestimates the aortic root arterial blood pressure and causes excessive vasopressor and worse outcomes. Brachial and femoral artery monitoring is well tolerated and should be considered in critically ill patients expected to be on high dose pressors. The pulmonary artery catheter is the gold standard of hemodynamic monitoring and is still widely used in liver transplantation; however, it is a highly invasive monitor with potential for serious complications and most of its data can be obtained by other less invasive monitors. Rescue transesophageal echocardiography relies on few simple views and should be available as a standby to manage sudden hemodynamic instability. Risk of esophageal bleeding from transesophageal echocardiography in liver transplantation is the same as in other patient populations. The arterial pulse waveform analysis based cardiac output devices are minimally invasive and have the advantage of real-time beat to beat monitoring of cardiac output. No hemodynamic monitor can improve clinical outcomes unless integrated into a goal-directed hemodynamic therapy. The hemodynamic monitoring technique should be tailored to the patient's medical status, surgical technique, and the anesthesiologist's level of expertise. SUMMARY The current article provides a review of the current hemodynamic monitoring systems and their integration in goal-directed hemodynamic therapy.
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Affiliation(s)
- Sherif Kandil
- Department of Anesthesiology, Keck Medical School of USC, Los Angeles, California, USA
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8
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Gore P, Liu H, Bohringer C. Can Currently Available Non-invasive Continuous Blood Pressure Monitors Replace Invasive Measurement With an Arterial Catheter? Cureus 2024; 16:e54707. [PMID: 38529464 PMCID: PMC10961923 DOI: 10.7759/cureus.54707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Deviations from normal blood pressure (BP) during general anesthesia have been clearly linked to several adverse outcomes. Measuring BP accurately is therefore critically important for producing excellent outcomes in health care. Normal BP does not necessarily guarantee adequate organ perfusion however and adverse events have occurred even when BP seemed adequate. Invasive blood pressure monitoring has recently evolved beyond merely measuring BP. Arterial line-derived pulse contour analysis is used now to assess both cardiac output and stroke volume variation as indices of adequate intravascular volume. Confirmation of acceptable cardiac output with data derived from invasive intra-arterial catheters has become very important when managing high-risk patients. Newer devices that measure BP continuously and non-invasively in the digital arteries via a finger cuff have also become available. Many clinicians contemplate now if these new devices are ready to replace invasive monitoring with an arterial catheter. Unlike non-invasive devices, intra-arterial catheters allow frequent blood sampling. This makes it possible to assess vital parameters like pH, hemoglobin concentration, ionized calcium, potassium, glucose, and arterial partial pressure of oxygen and carbon dioxide frequently. Non-invasive continuous BP measurement has been found to be unreliable in critically ill patients, the elderly, and patients with calcified arteries. Pulse contour-derived estimates of cardiac output and stroke volume variation have been validated better with data derived from arterial lines than that from the newer finger cuff monitors. Significant advances have been recently made with non-invasive continuous BP monitors. Invasive monitoring with an arterial line however remains the gold standard for measuring BP and assessing pulse contour analysis-derived hemodynamic variables in critically ill patients. In the future, non-invasive continuous BP monitors will likely replace intermittent oscillometers in the operating room and the postoperative period. They will however not eliminate the need for arterial catheterization in critically ill patients.
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Affiliation(s)
- Payton Gore
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
| | - Hong Liu
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
| | - Christian Bohringer
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
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9
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Benson B, Belle A, Lee S, Bassin BS, Medlin RP, Sjoding MW, Ward KR. Prediction of episode of hemodynamic instability using an electrocardiogram based analytic: a retrospective cohort study. BMC Anesthesiol 2023; 23:324. [PMID: 37737164 PMCID: PMC10515416 DOI: 10.1186/s12871-023-02283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Predicting the onset of hemodynamic instability before it occurs remains a sought-after goal in acute and critical care medicine. Technologies that allow for this may assist clinicians in preventing episodes of hemodynamic instability (EHI). We tested a novel noninvasive technology, the Analytic for Hemodynamic Instability-Predictive Indicator (AHI-PI), which analyzes a single lead of electrocardiogram (ECG) and extracts heart rate variability and morphologic waveform features to predict an EHI prior to its occurrence. METHODS Retrospective cohort study at a quaternary care academic health system using data from hospitalized adult patients between August 2019 and April 2020 undergoing continuous ECG monitoring with intermittent noninvasive blood pressure (NIBP) or with continuous intraarterial pressure (IAP) monitoring. RESULTS AHI-PI's low and high-risk indications were compared with the presence of EHI in the future as indicated by vital signs (heart rate > 100 beats/min with a systolic blood pressure < 90 mmHg or a mean arterial blood pressure of < 70 mmHg). 4,633 patients were analyzed (3,961 undergoing NIBP monitoring, 672 with continuous IAP monitoring). 692 patients had an EHI (380 undergoing NIBP, 312 undergoing IAP). For IAP patients, the sensitivity and specificity of AHI-PI to predict EHI was 89.7% and 78.3% with a positive and negative predictive value of 33.7% and 98.4% respectively. For NIBP patients, AHI-PI had a sensitivity and specificity of 86.3% and 80.5% with a positive and negative predictive value of 11.7% and 99.5% respectively. Both groups performed with an AUC of 0.87. AHI-PI predicted EHI in both groups with a median lead time of 1.1 h (average lead time of 3.7 h for IAP group, 2.9 h for NIBP group). CONCLUSIONS AHI-PI predicted EHIs with high sensitivity and specificity and within clinically significant time windows that may allow for intervention. Performance was similar in patients undergoing NIBP and IAP monitoring.
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Affiliation(s)
- Bryce Benson
- Fifth Eye Inc, 110 Miller Avenue, Suite 300, Ann Arbor, MI, 48104, USA
| | - Ashwin Belle
- Fifth Eye Inc, 110 Miller Avenue, Suite 300, Ann Arbor, MI, 48104, USA
| | - Sooin Lee
- Fifth Eye Inc, 110 Miller Avenue, Suite 300, Ann Arbor, MI, 48104, USA
| | - Benjamin S Bassin
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5301, USA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, NCRC 10-A103 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Richard P Medlin
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5301, USA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, NCRC 10-A103 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Michael W Sjoding
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, NCRC 10-A103 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5642, USA
| | - Kevin R Ward
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5301, USA.
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, NCRC 10-A103 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
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10
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Yu Y, Gong Y, Hu B, Ouyang B, Pan A, Liu J, Liu F, Shang XL, Yang XH, Tu G, Wang C, Ma S, Fang W, Liu L, Liu J, Chen D. Expert consensus on blood pressure management in critically ill patients. JOURNAL OF INTENSIVE MEDICINE 2023; 3:185-203. [PMID: 37533806 PMCID: PMC10391579 DOI: 10.1016/j.jointm.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Yuetian Yu
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China
| | - Ye Gong
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Bin Ouyang
- Department of Critical Care Medicine, The First Affiliated Hospital of SunYatsen University, Guangzhou 510080, Guangdong, China
| | - Aijun Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, Anhui, China
| | - Jinglun Liu
- Department of Emergency Medicine and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fen Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi, China
| | - Xiu-Ling Shang
- Department of Critical Care Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou 350001 Fujian, China
| | - Xiang-Hong Yang
- Department of Intensive Care Unit, Emergency & Intensive Care Unit Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310014 Zhejiang, China
| | - Guowei Tu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Changsong Wang
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China
| | - Shaolin Ma
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Wei Fang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, 250014 Shandong, China
| | - Ling Liu
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu, China
| | - Jiao Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Garagnani M, Mollura M, Barbieri R. Statistical shape modeling-based algorithm for replacing missing beats in blood pressure signals. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083255 DOI: 10.1109/embc40787.2023.10340122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
In clinical environments, such as the Intensive Care Unit (ICU), continuous and uninterrupted monitoring of vital signs is critical for the early detection of patient deterioration and prompt intervention. Since data collected in these settings are often corrupted by noise, artifacts, or recording gaps, it is important to estimate missing data for a more accurate signal assessment.In this study, we propose an automatic algorithm for reconstructing of arterial blood pressure signal waveforms. The methodological core of the algorithm is based on the idea of statistical shape modeling, which basically estimates the shape variation of beat waveforms in order to reconstruct them in noisy segments. The waveform reconstruction is achieved by combining the average beat template from a 90-second segment of clean signal preceding the gap with the main shape variations of the estimated waveform.The algorithm was validated using arterial blood pressure recordings from 9 subjects admitted in the ICU and collected in the MIMIC-III Waveform Database, each lasting 1 hour and sampled at 125 Hz. For each record, ten fictitious gaps were created, and the reconstructed segments were compared to the original signals with the metrics proposed within the PhysioNet / Computing in Cardiology Challenge 2010. Results demonstrate the excellent performance of the proposed algorithm, with overall averages of both Q1 and Q2 metrics greater than 0.85.
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12
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Manga S, Muthavarapu N, Redij R, Baraskar B, Kaur A, Gaddam S, Gopalakrishnan K, Shinde R, Rajagopal A, Samaddar P, Damani DN, Shivaram S, Dey S, Mitra D, Roy S, Kulkarni K, Arunachalam SP. Estimation of Physiologic Pressures: Invasive and Non-Invasive Techniques, AI Models, and Future Perspectives. SENSORS (BASEL, SWITZERLAND) 2023; 23:5744. [PMID: 37420919 DOI: 10.3390/s23125744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/25/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Abstract
The measurement of physiologic pressure helps diagnose and prevent associated health complications. From typical conventional methods to more complicated modalities, such as the estimation of intracranial pressures, numerous invasive and noninvasive tools that provide us with insight into daily physiology and aid in understanding pathology are within our grasp. Currently, our standards for estimating vital pressures, including continuous BP measurements, pulmonary capillary wedge pressures, and hepatic portal gradients, involve the use of invasive modalities. As an emerging field in medical technology, artificial intelligence (AI) has been incorporated into analyzing and predicting patterns of physiologic pressures. AI has been used to construct models that have clinical applicability both in hospital settings and at-home settings for ease of use for patients. Studies applying AI to each of these compartmental pressures were searched and shortlisted for thorough assessment and review. There are several AI-based innovations in noninvasive blood pressure estimation based on imaging, auscultation, oscillometry and wearable technology employing biosignals. The purpose of this review is to provide an in-depth assessment of the involved physiologies, prevailing methodologies and emerging technologies incorporating AI in clinical practice for each type of compartmental pressure measurement. We also bring to the forefront AI-based noninvasive estimation techniques for physiologic pressure based on microwave systems that have promising potential for clinical practice.
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Affiliation(s)
- Sharanya Manga
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Neha Muthavarapu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Renisha Redij
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Avneet Kaur
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sunil Gaddam
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Keerthy Gopalakrishnan
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Rutuja Shinde
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Poulami Samaddar
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Devanshi N Damani
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79995, USA
| | - Suganti Shivaram
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Shuvashis Dey
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Electrical and Computer Engineering, North Dakota State University, Fargo, ND 58105, USA
| | - Dipankar Mitra
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Computer Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Sayan Roy
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Electrical Engineering and Computer Science, South Dakota Mines, Rapid City, SD 57701, USA
| | - Kanchan Kulkarni
- Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, U1045, 33000 Bordeaux, France
- IHU Liryc, Heart Rhythm Disease Institute, Fondation Bordeaux Université, Bordeaux, 33600 Pessac, France
| | - Shivaram P Arunachalam
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Li Y, Wang B, Fan F, Weng H, Zhang L, Jiang J, Zheng B, Zhang Y, Li J. Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring in ICU patients from a large real-world database. J Hypertens 2023; 41:838-844. [PMID: 36883447 DOI: 10.1097/hjh.0000000000003408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Oscillometric blood pressure (BP) measurement in atrial fibrillation patients is controversial due to stroke volume variation. Here, we performed a cross-sectional study to investigate the impact of atrial fibrillation on the accuracy of oscillometric BP in the ICU setting. METHODS Adult patients with atrial fibrillation or sinus rhythm records were enrolled from Medical Information Mart for Intensive Care-III database. Concurrently recorded noninvasive oscillometric BPs (NIBPs) and intra-arterial BPs (IBPs) were classified as atrial fibrillation or sinus rhythm group according to heart rhythm. Bland-Altmann plots assessed bias and limits of agreement of NIBP to IBP. Pairwise comparison was performed on NIBP/IBP bias between atrial fibrillation and sinus rhythm. Linear mixed-effect model was used to assess the impact of heart rhythm on NIBP/IBP bias after adjusting confounders. RESULTS Two thousand, three hundred and thirty-five patients (71.95 ± 11.23 years old, 60.90% were men) were included. Systolic, diastolic, and mean NIBP/IBP biases were not clinically different between atrial fibrillation and sinus rhythm circumstances (SBP bias: 0.66 vs. 1.21 mmHg, P = 0.002; DBP: -5.29 vs. -5.17, P = 0.1; mean BP: -4.45 vs. -4.19, P = 0.01). After adjusting for age, sex, heart rate, arterial BP, and vasopressor usage, the effect of heart rhythm on NIBP/IBP bias was within ±5 mmHg for SBP and DBP [effect on SBP bias: 3.32 mmHg (95% confidence interval (CI) 2.89-3.74), P < 0.001; DBP: -0.89 (-1.17 to -0.60), P < 0.001], while the effect on mean BP bias was not significant [0.18 mmHg (-0.10 to 0.46), P = 0.2]. CONCLUSION Atrial fibrillation would not influence the agreement of oscillometric BP to IBP in ICU patients compared with sinus rhythm.
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Affiliation(s)
- Yuxi Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
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14
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Prediction of acute hypertensive episodes in critically ill patients. Artif Intell Med 2023; 139:102525. [PMID: 37100504 DOI: 10.1016/j.artmed.2023.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 01/19/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Prevention and treatment of complications are the backbone of medical care, particularly in critical care settings. Early detection and prompt intervention can potentially prevent complications from occurring and improve outcomes. In this study, we use four longitudinal vital signs variables of intensive care unit patients, focusing on predicting acute hypertensive episodes (AHEs). These episodes represent elevations in blood pressure and may result in clinical damage or indicate a change in a patient's clinical situation, such as an elevation in intracranial pressure or kidney failure. Prediction of AHEs may allow clinicians to anticipate changes in the patient's condition and respond early on to prevent these from occurring. Temporal abstraction was employed to transform the multivariate temporal data into a uniform representation of symbolic time intervals, from which frequent time-intervals-related patterns (TIRPs) are mined and used as features for AHE prediction. A novel TIRP metric for classification, called coverage, is introduced that measures the coverage of a TIRP's instances in a time window. For comparison, several baseline models were applied on the raw time series data, including logistic regression and sequential deep learning models, are used. Our results show that using frequent TIRPs as features outperforms the baseline models, and the use of the coverage, metric outperforms other TIRP metrics. Two approaches to predicting AHEs in real-life application conditions are evaluated: using a sliding window to continuously predict whether a patient would experience an AHE within a specific prediction time period ahead, our models produced an AUC-ROC of 82%, but with low AUPRC. Alternatively, predicting whether an AHE would generally occur during the entire admission resulted in an AUC-ROC of 74%.
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15
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Kaplan E, Kadmon G, Nahum E, Alfandary H, Haskin O, Weissbach A. Blood pressure monitoring following kidney transplantation in children: a comparison of invasive and noninvasive measurements using Doppler as a benchmark technique. Pediatr Nephrol 2023; 38:1291-1298. [PMID: 35913567 DOI: 10.1007/s00467-022-05691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blood pressure (BP) monitoring following pediatric kidney transplantation is essential for optimizing graft perfusion. Differences between invasive BP and noninvasive BP (NIBP) measurements are sometimes considerable. We aimed to assess agreement between invasive BP and NIBP in pediatric patients after kidney transplantation and compare with measurements obtained by systolic Doppler with manual sphygmomanometer as a reference technique. METHODS A prospective, observational cohort study, of children aged 18 years or younger, admitted immediately following kidney transplantation to the pediatric intensive care unit of a tertiary, university-affiliated medical center, between May 2019 and June 2021. RESULTS Eighty-two paired simultaneous measurements of invasive BP, NIBP, and Doppler BP in 18 patients were compared. Patients were significantly hypertensive, with mean systolic NIBP above the 95th percentile (96 ± 6%). Systolic invasive BP measurements were significantly higher than NIBP (149 ± 20 vs. 136 ± 15 mmHg, p < 0.001). Substantial differences (≥ 20 mmHg) were found in 23% (95% CI 15-34%). Similar disagreement was found between systolic invasive and Doppler BP (150 ± 23 and 137 ± 17 mmHg, respectively, p < 0.001). In contrast, systolic NIBP was in good agreement with Doppler BP (135 ± 17 and 138 ± 18, respectively, p = 0.27). A moderate to strong correlation was found between higher systolic invasive BP and the difference to systolic Doppler BP (Spearman's ρ = 0.63, p < 0.001). CONCLUSIONS In children immediately following kidney transplantation, clinically significant disagreement was found between invasive and noninvasive BP measurements. Invasive BP values were significantly higher than those obtained by Doppler. Better agreement was found between NIBP and Doppler. These issues should be considered when interpreting BP measurements in this sensitive patient population. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Eytan Kaplan
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
| | - Gili Kadmon
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Elhanan Nahum
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Hadas Alfandary
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.,Institute of Nephrology, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel
| | - Orly Haskin
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.,Institute of Nephrology, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel
| | - Avichai Weissbach
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
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De Georgia M, Bowen T, Duncan KR, Chebl AB. Blood pressure management in ischemic stroke patients undergoing mechanical thrombectomy. Neurol Res Pract 2023; 5:12. [PMID: 36991520 PMCID: PMC10061853 DOI: 10.1186/s42466-023-00238-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
The relationship between presenting blood pressure in acute ischemic stroke patients and outcome is complex. Several studies have demonstrated a U-shaped curve with worse outcomes when blood pressure is high or low. The American Heart Association/American Stroke Association guidelines recommend values of blood pressure < 185/110 mmHg in patients treated with intravenous t-PA and "permissive hypertension" up to 220/120 mmHg in those not treated with intravenous t-PA. The optimal blood pressure target is less clear in patients undergoing mechanical thrombectomy. Before thrombectomy, the guidelines recommend a blood pressure < 185/110 mmHg though patients with even lower systolic blood pressures may have better outcomes. During and after thrombectomy, the guidelines recommend a blood pressure < 180/105 mmHg. However, several studies have suggested that during thrombectomy the primary goal should be to prevent significant low blood pressure (e.g., target systolic blood pressure > 140 mmHg or MAP > 70 mmHg). After thrombectomy, the primary goal should be to prevent high blood pressure (e.g., target systolic blood pressure < 160 mmHg or MAP < 90 mmHg). To make more specific recommendations, large, randomized-control studies are needed that address factors such as the baseline blood pressure, timing and degree of revascularization, status of collaterals, and estimated risk of reperfusion injury.
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Affiliation(s)
- Michael De Georgia
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Theodore Bowen
- Department of Neurology, MetroHealth Medical Center, Cleveland, OH, USA
| | - K Rose Duncan
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Alex Bou Chebl
- Department of Neurology, Henry Ford Medical Center, Detroit, MI, USA
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Miller DR, Dhillon GS, Bambos N, Shin AY, Scheinker D. WAVES - The Lucile Packard Children's Hospital Pediatric Physiological Waveforms Dataset. Sci Data 2023; 10:124. [PMID: 36882443 PMCID: PMC9992360 DOI: 10.1038/s41597-023-02037-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023] Open
Abstract
WAVES is a large, single-center dataset comprising 9 years of high-frequency physiological waveform data from patients in intensive and acute care units at a large academic, pediatric medical center. The data comprise approximately 10.6 million hours of 1 to 20 concurrent waveforms over approximately 50,364 distinct patient encounters. The data have been de-identified, cleaned, and organized to facilitate research. Initial analyses demonstrate the potential of the data for clinical applications such as non-invasive blood pressure monitoring and methodological applications such as waveform-agnostic data imputation. WAVES is the largest pediatric-focused and second largest physiological waveform dataset available for research.
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Affiliation(s)
- Daniel R Miller
- Stanford University; Department of Electrical Engineering, Palo Alto, CA, 94304, USA
| | - Gurpreet S Dhillon
- Stanford University School of Medicine; Lucile Packard Children's Hospital at Stanford; Department of Pediatrics, Division of Pediatric Cardiology, Palo Alto, CA, 94304, USA
| | - Nicholas Bambos
- Stanford University; Department of Electrical Engineering, Palo Alto, CA, 94304, USA
- Stanford University; Department of Management Science and Engineering, Palo Alto, CA, 94304, USA
| | - Andrew Y Shin
- Stanford University School of Medicine; Lucile Packard Children's Hospital at Stanford; Department of Pediatrics, Division of Pediatric Cardiology, Palo Alto, CA, 94304, USA.
| | - David Scheinker
- Stanford University; Department of Management Science and Engineering, Palo Alto, CA, 94304, USA.
- Stanford University; Clinical Excellence Research Center, Palo Alto, CA, 94304, USA.
- Stanford University School of Medicine; Lucile Packard Children's Hospital at Stanford; Department of Pediatrics, Division of Pediatric Endocrinology, Palo Alto, CA, 94304, USA.
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Abstract
An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion. At present, the potential risk factors, mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation received relatively limited attention among nephrologists and represent an opportunity to look beyond mere blood pressure and intake-output balances. Careful charting and reporting duration and extent of surgical pneumoperitoneum represents an opportunity for anesthesia teams to better communicate intraoperative factors affecting renal outcomes for the postoperative clinical teams. In this current article, the authors are integrating preclinical data and clinical experience to provide a better understanding to optimize renal perfusion during surgeries. Future studies should carefully consider intrabdominal insufflation pressure as a key variable when assessing outcomes and blood pressure goals in these settings.
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EVALUATION OF AGREEMENT BETWEEN OSCILLOMETRIC AND DIRECT BLOOD PRESSURE MEASUREMENTS IN ANESTHETIZED TIGERS ( PANTHERA TIGRIS). J Zoo Wildl Med 2023; 53:777-784. [PMID: 36640079 DOI: 10.1638/2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 01/09/2023] Open
Abstract
Noninvasive blood pressure measurement is commonly performed with oscillometry; however, this technique provides clinically helpful information only if it is representative of the gold standard. Agreement between direct and oscillometric blood pressure measurements were performed in 14 anesthetized, captive tigers (Panthera tigris). A cuff, placed around the tail base and connected to a multiparameter monitor, was used to measure arterial blood pressure oscillometrically and provided systolic, mean, and diastolic pressures. At the same time, direct blood pressures were obtained from a dorsal pedal arterial catheter, and the oscillometric and direct readings were considered paired data points. Agreement between the two methods was evaluated by Bland-Altman plots. All animals completed the study and provided 196 paired data points. The bias (mm Hg) for systolic, mean, and diastolic arterial pressures was -3.7, -0.8, and -1.6, respectively. Limits of agreement (mm Hg) for systolic, mean, and diastolic arterial pressures were -31 to 24, -29 to 27, and -29 to 26, respectively. Oscillometry provided an acceptable amount of readings within 10 and 20 mm Hg of the gold standard. The oscillometric technique provided reasonable agreement with direct measurements. Therefore, in the conditions used in this study, oscillometric blood pressure measured via the ventral coccygeal artery provided reasonable estimates of invasive blood pressure in anesthetized tigers.
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Xiao W, Liu W, Zhang J, Liu Y, Hua T, Yang M. The association of diastolic arterial pressure and heart rate with mortality in septic shock: a retrospective cohort study. Eur J Med Res 2022; 27:285. [PMID: 36496399 PMCID: PMC9738025 DOI: 10.1186/s40001-022-00930-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The effects of diastolic arterial pressure (DAP) and heart rate (HR) on the prognosis of patients with septic shock are unclear, and whether these effects persist over time is unknown. We aimed to investigate the relationship between exposure to different intensities of DAP and HR over time and mortality at 28 days in patients with septic shock. METHODS In this cohort study, we obtained data from the Medical Information Mart for Intensive Care IV, which includes the data of adult patients (≥ 18 years) with septic shock who underwent invasive blood pressure monitoring. We excluded patients who received extracorporeal membrane oxygenation (ECMO) or glucocorticoids within 48 h of ICU admission. The primary outcome was mortality at 28 days. Piece-wise exponential additive mixed models were used to estimate the strength of the associations over time. RESULTS In total, 4959 patients were finally included. The median length of stay in the ICU was 3.2 days (IQR: 1.5-7.1 days), and the mortality in the ICU was 12.9%, with a total mortality at 28 days of 15.9%. After adjustment for baseline and time-dependent confounders, both daily time-weighted average (TWA) DAP and HR were associated with increased mortality at 28 days and strong association, mainly in the early to mid-stages of the disease. The results showed that mortality in patients with septic shock was lowest at a DAP of 50-70 mm Hg and an HR of 60-90 beats per minute (bpm). Throughout, a significant increase in the risk of death was found with daily exposure to TWA-DAP ≤ 40 mmHg (hazard ratio 0.99, 95% confidence interval (CI) 0.94-1.03) or TWA-HR ≥ 100 bpm (hazard ratio 1.16, 95% CI 1.1-1.21). Cumulative and interactive effects of harmful exposure (TWA-DAP ≤ 40 mmHg and TWA-HR ≥ 100 bpm) were also observed. CONCLUSION The optimal ranges for DAP and HR in patients with septic shock are 50-70 mmHg and 60-90 bpm, respectively. The cumulative and interactive effects of exposure to low DAP (≤ 40 mmHg) and tachycardia (≥ 100 bpm) were associated with an increased risk of death.
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Affiliation(s)
- Wenyan Xiao
- grid.452696.a0000 0004 7533 3408The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408Research Center for Translational Medicine, the Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China
| | - Wanjun Liu
- grid.452696.a0000 0004 7533 3408The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408Research Center for Translational Medicine, the Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China
| | - Jin Zhang
- grid.452696.a0000 0004 7533 3408The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408Research Center for Translational Medicine, the Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China
| | - Yu Liu
- grid.252245.60000 0001 0085 4987Key Laboratory of Intelligent Computing and Signal Processing, Anhui University, Ministry of Education, Hefei, Anhui 230601 People’s Republic of China ,grid.252245.60000 0001 0085 4987School of Integrated Circuits, Anhui University, Anhui, 230601 Hefei People’s Republic of China
| | - Tianfeng Hua
- grid.452696.a0000 0004 7533 3408The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408Research Center for Translational Medicine, the Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China
| | - Min Yang
- grid.452696.a0000 0004 7533 3408The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China ,grid.452696.a0000 0004 7533 3408Research Center for Translational Medicine, the Second Affiliated Hospital of Anhui Medical University, Anhui, 230601 Hefei People’s Republic of China
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Kumar S, Yadav S, Kumar A. Oscillometric Waveform Evaluation for Blood Pressure Devices. BIOMEDICAL ENGINEERING ADVANCES 2022. [DOI: 10.1016/j.bea.2022.100046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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22
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Abiri A, Chou EF, Qian C, Rinehart J, Khine M. Intra-beat biomarker for accurate continuous non-invasive blood pressure monitoring. Sci Rep 2022; 12:16772. [PMID: 36202815 PMCID: PMC9537243 DOI: 10.1038/s41598-022-19096-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Accurate continuous non-invasive blood pressure (CNIBP) monitoring is the holy grail of digital medicine but remains elusive largely due to significant drifts in signal and motion artifacts that necessitate frequent device recalibration. To address these challenges, we developed a unique approach by creating a novel intra-beat biomarker (Diastolic Transit Time, DTT) to achieve highly accurate blood pressure (BP) estimations. We demonstrated our approach’s superior performance, compared to other common signal processing techniques, in eliminating stochastic baseline wander, while maintaining signal integrity and measurement accuracy, even during significant hemodynamic changes. We applied this new algorithm to BP data collected using non-invasive sensors from a diverse cohort of high acuity patients and demonstrated that we could achieve close agreement with the gold standard invasive arterial line BP measurements, for up to 20 min without recalibration. We established our approach's generalizability by successfully applying it to pulse waveforms obtained from various sensors, including photoplethysmography and capacitive-based pressure sensors. Our algorithm also maintained signal integrity, enabling reliable assessments of BP variability. Moreover, our algorithm demonstrated tolerance to both low- and high-frequency motion artifacts during abrupt hand movements and prolonged periods of walking. Thus, our approach shows promise in constituting a necessary advance and can be applied to a wide range of wearable sensors for CNIBP monitoring in the ambulatory and inpatient settings.
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Affiliation(s)
- Arash Abiri
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, 92697, USA
| | - En-Fan Chou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, 92697, USA
| | - Chengyang Qian
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, 92697, USA
| | - Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California, Irvine Medical Center, Orange, CA, USA
| | - Michelle Khine
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, 92697, USA.
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Yao J, Liu D, Huang W, Fang Y, Yang Y, Li Y, Liu P, Pan X. Increased variability of mean arterial pressure is associated with increased risk of short-term mortality in intensive care unit: A retrospective study. Front Neurol 2022; 13:999540. [PMID: 36247784 PMCID: PMC9557059 DOI: 10.3389/fneur.2022.999540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIn intensive care unit (ICU), what thresholds of MAP variability are effective in distinguishing low- and high-risk patients for short-term mortality (in-hospital and 28-day) remains unclear.MethodsFifteen thousand five hundred sixty adult subjects admitted to ICU at Beth Israel Deaconess Medical Center (Boston, USA) between 2001 and 2012 were included in this retrospective study from MIMIC-III database. MAP within the first 24 h after admission were collected. Quantiles of MAP variability from 10% to 90% with 10% increasement each were considered to divide study participants into two groups, either having coefficients of variation of MAP greater or less than the given threshold. The threshold of MAP variability was identified by maximizing the odds ratio associated with increased risk of short-term mortality (in-hospital and 28-day). Logistic regression and Cox regression models were further applied to evaluate the association between increased variability of MAP and short-term mortality (in-hospital and 28-day).Results90% quantile of MAP variability was determined as the threshold generating the largest odds ratio associated with the increased risk of short-term mortality. Increased MAP variability, especially over 90% of MAP variability, was associated with increased risk of in-hospital mortality (odds ratio: 2.351, 95% CI: 2.064–2.673), and 28-day mortality (hazard ratio: 2.064, 95% CI: 1.820–2.337).ConclusionIncreased MAP variability, especially over 90% of MAP variability, is associated with short-term mortality. Our proposed threshold of MAP variability may aid in the early identification of critically ill patients with a high risk of mortality.
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Affiliation(s)
- Jia Yao
- Department of Mathematics, Shanghai Normal University, Shanghai, China
| | - Dandan Liu
- Department of Mathematics, Shanghai Normal University, Shanghai, China
| | - Weifeng Huang
- Department of Critical Care Medicine, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuexin Fang
- Department of Mathematics, Shanghai Normal University, Shanghai, China
| | - Yifan Yang
- Department of Mathematics, Shanghai Normal University, Shanghai, China
| | - Yingchuan Li
- Department of Critical Care Medicine, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Pengyuan Liu
- Department of Respiratory Medicine, Sir Run Run Shaw Hospital and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Pengyuan Liu
| | - Xiaoqing Pan
- Department of Mathematics, Shanghai Normal University, Shanghai, China
- *Correspondence: Xiaoqing Pan
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Vats V, Nagori A, Singh P, Dutt R, Bandhey H, Wason M, Lodha R, Sethi T. Early Prediction of Hemodynamic Shock in Pediatric Intensive Care Units With Deep Learning on Thermal Videos. Front Physiol 2022; 13:862411. [PMID: 35923238 PMCID: PMC9340772 DOI: 10.3389/fphys.2022.862411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Shock is one of the major killers in intensive care units, and early interventions can potentially reverse it. In this study, we advance a noncontact thermal imaging modality for continuous monitoring of hemodynamic shock working on 1,03,936 frames from 406 videos recorded longitudinally upon 22 pediatric patients. Deep learning was used to preprocess and extract the Center-to-Peripheral Difference (CPD) in temperature values from the videos. This time-series data along with the heart rate was finally analyzed using Long-Short Term Memory models to predict the shock status up to the next 6 h. Our models achieved the best area under the receiver operating characteristic curve of 0.81 ± 0.06 and area under the precision-recall curve of 0.78 ± 0.05 at 5 h, providing sufficient time to stabilize the patient. Our approach, thus, provides a reliable shock prediction using an automated decision pipeline that can provide better care and save lives.
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Affiliation(s)
- Vanshika Vats
- Indraprastha Institute of Information Technology, Delhi, India
| | - Aditya Nagori
- Indraprastha Institute of Information Technology, Delhi, India
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Pradeep Singh
- Indraprastha Institute of Information Technology, Delhi, India
| | - Raman Dutt
- Computer Science and Engineering, Shiv Nadar University, Greater Noida, India
| | - Harsh Bandhey
- Indraprastha Institute of Information Technology, Delhi, India
| | - Mahika Wason
- Indraprastha Institute of Information Technology, Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Tavpritesh Sethi
- Indraprastha Institute of Information Technology, Delhi, India
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
- *Correspondence: Tavpritesh Sethi,
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Arterial catheterization and in-hospital mortality in sepsis: a propensity score-matched study. BMC Anesthesiol 2022; 22:178. [PMID: 35681122 PMCID: PMC9178844 DOI: 10.1186/s12871-022-01722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background Despite the extensive use of arterial catheterization (AC), clinical effectiveness of AC to alter the outcomes among patients with sepsis and septic shock has not been evaluated. The purpose of this study is to examine the association between the use of AC and in-hospital mortality in septic patients. Methods Adult patients with sepsis from Medical Information Mart for Intensive Care database were screened to conduct this retrospective observational study. Propensity score matching (PSM) was employed to estimate the relationship between arterial catheterization (AC) and in-hospital mortality. Multivariable logistic regression and inverse probability of treatment weighing (IPTW) were used to validate our findings. Results A total of 14,509 septic patients without shock and 4,078 septic shock patients were identified. 3,489 pairs in sepsis patients without shock and 589 pairs in septic shock patients were yielded respectively after PSM. For patients in the sepsis without shock group, AC placement was associated with increased in-hospital mortality (OR, 1.34; 95% CI, 1.17–1.54; p < 0.001). In the septic shock group, there was no significant difference in hospital mortality between AC group and non-AC group. The results of logistic regression and propensity score IPTW model support our findings. Conclusions In hemodynamically stable septic patients, AC is independently associated with higher in-hospital mortality, while in patients with septic shock, AC was not associated with improvements in hospital mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01722-5.
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Schmitzberger FF, Hall AE, Hughes ME, Belle A, Benson B, Ward KR, Bassin BS. Detection of Hemodynamic Status Using an Analytic Based on an Electrocardiogram Lead Waveform. Crit Care Explor 2022; 4:e0693. [PMID: 35620767 PMCID: PMC9116956 DOI: 10.1097/cce.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Delayed identification of hemodynamic deterioration remains a persistent issue for in-hospital patient care. Clinicians continue to rely on vital signs associated with tachycardia and hypotension to identify hemodynamically unstable patients. A novel, noninvasive technology, the Analytic for Hemodynamic Instability (AHI), uses only the continuous electrocardiogram (ECG) signal from a typical hospital multiparameter telemetry monitor to monitor hemodynamics. The intent of this study was to determine if AHI is able to predict hemodynamic instability without the need for continuous direct measurement of blood pressure. DESIGN Retrospective cohort study. SETTING Single quaternary care academic health system in Michigan. PATIENTS Hospitalized adult patients between November 2019 and February 2020 undergoing continuous ECG and intra-arterial blood pressure monitoring in an intensive care setting. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS One million two hundred fifty-two thousand seven hundred forty-two 5-minute windows of the analytic output were analyzed from 597 consecutive adult patients. AHI outputs were compared with vital sign indications of hemodynamic instability (heart rate > 100 beats/min, systolic blood pressure < 90 mm Hg, and shock index of > 1) in the same window. The observed sensitivity and specificity of AHI were 96.9% and 79.0%, respectively, with an area under the curve (AUC) of 0.90 for heart rate and systolic blood pressure. For the shock index analysis, AHI's sensitivity was 72.0% and specificity was 80.3% with an AUC of 0.81. CONCLUSIONS The AHI-derived hemodynamic status appropriately detected the various gold standard indications of hemodynamic instability (hypotension, tachycardia and hypotension, and shock index > 1). AHI may provide continuous dynamic hemodynamic monitoring capabilities in patients who traditionally have intermittent static vital sign measurements.
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Affiliation(s)
| | - Ashley E Hall
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI
| | - Morgan E Hughes
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI
| | | | | | - Kevin R Ward
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI
- Department of Emergency Medicine, Division of Critical Care, Michigan Medicine, Ann Arbor, MI
- Max Harry Weil Institute for Critical Care Research and Innovation, Michigan Medicine, Ann Arbor, MI
| | - Benjamin S Bassin
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI
- Department of Emergency Medicine, Division of Critical Care, Michigan Medicine, Ann Arbor, MI
- Max Harry Weil Institute for Critical Care Research and Innovation, Michigan Medicine, Ann Arbor, MI
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Garg RK, Ouyang B, Zwein A, Thavapalan V, Indavarapu A, Cheponis K, Osteraas N, Ezzeldin M, Pandya V, Ramesh A, Bleck TP. Systolic blood pressure measurements are unreliable for the management of acute spontaneous intracerebral hemorrhage. J Crit Care 2022; 70:154049. [PMID: 35490501 DOI: 10.1016/j.jcrc.2022.154049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Whether systolic blood pressure (SBP) is reliable in acute spontaneous intracerebral (sICH) by assessing agreement between simultaneous BP measurements obtained from cuff non-invasive blood pressure (NIBP) and radial arterial invasive blood pressure (AIBP) devices. MATERIAL AND METHODS Among 766 prospectively screened sICH subjects, 303 (39.5%) had NIBP and AIBP measurements. During the first 24 h, 2157 simultaneous paired measurement readings were abstracted. Paired NIBP/AIBP measurements were included in a Bland-Altman technique with 95% agreement limits and coefficients from regression analysis derived from a bootstrap procedure. RESULTS Variance for SBP was 66.1 mmHg, which was larger than the 44.3 mg Hg for diastolic blood pressure (DBP) or the 46.1 mmHg for mean arterial pressure (MAP). Pairwise comparison of mean biases showed a significant difference between SBP when compared to DBP (p < 0.0001) or MAP (p < 0.0001). The mean bias between DBP and MAP was not different (p = 0.68). Regression-based Bland Altman analysis found significant bias (slope -0.16, 95% CI -0.23, -0.09, p < 0.05) over the range of mean SBP. Bias over the range of mean DBP or MAP was not significant. CONCLUSIONS We concluded that SBP is an unreliable blood pressure measurement in patients with sICH.
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Affiliation(s)
- Rajeev K Garg
- Rush University Medical Center, Department of Neurological Sciences, 1725 West Harrison Street, Suite 1106, Chicago, IL 60612, USA.
| | - Bichun Ouyang
- Rush University Medical Center, Department of Neurological Sciences, 1725 West Harrison Street, Suite 1106, Chicago, IL 60612, USA
| | - Amer Zwein
- Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY 10467, USA
| | - Varoon Thavapalan
- Aurora St. Luke's Medical Center, Section of Neurology, 2901 W. Kinnickinnic River Parkway, Suite 315, Milwaukee, WI 53215, USA
| | - Ajit Indavarapu
- Hennepin Healthcare, Neurology, 730 S 8(th) Street, Minneapolis, MN 55401, USA
| | - Kathryn Cheponis
- Lehigh Valley Health, Neurology, 1250 S Cedar Crest Blvd Suite 405, Allentown, PA 18103, USA
| | - Nicholas Osteraas
- Rush University Medical Center, Department of Neurological Sciences, 1725 West Harrison Street, Suite 1106, Chicago, IL 60612, USA
| | - Mohamad Ezzeldin
- University of Houston, Neurology, 59 N, Bldg B, Suite 220, Kingwood, TX 77339, USA
| | - Vishal Pandya
- Johns Hopkins University, Department of Neurology, 601 N. Caroline St, Baltimore, MD 21287, USA
| | - Atul Ramesh
- Inova Fairfax Hospital, Neurocritical Care, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Thomas P Bleck
- Northwestern University, Division of Stroke and Neurocritical Care, 620 N Michigan Avenue, Suite 1150, Chicago, IL 60611, USA
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Jiang Y, Liu J, Peng W, Wang A, Guo L, Xu Z. Comparison of invasive blood pressure monitoring versus normal non-invasive blood pressure monitoring in ST-elevation myocardial infarction patients with percutaneous coronary intervention. Injury 2022; 53:1108-1113. [PMID: 34973831 DOI: 10.1016/j.injury.2021.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/13/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hypotension post percutaneous coronary intervention (PCI) causes stent thrombosis and reduced coronary perfusion, which aggravate myocardial ischemia and lead to patient death. Therefore, the accuracy and timeliness of blood pressure monitoring (BPM) are crucial for the nursing of patients post PCI. However, it is still controversial whether invasive blood pressure monitoring (IBPM) or non-invasive blood pressure monitoring (NIBPM) should be used for patients post PCI, and the magnitude of their assistance for patients' recovery remains unclear. METHODS A randomized controlled trial was performed in this study. 126 ST-segment elevation myocardial infarction (STEMI) patients post PCI were recruited and randomly divided into two groups (NIBPM group n = 63; IBPM group n = 63). RESULTS Clinical characteristics and physiological outcomes of participants received different BPM methods were collected and analyzed to compare the effects of these two methods on the nursing of PCI patients. Compared to NIBPM group, IBPM assisted to shorten the time of myocardial ischemia, promote coronary reperfusion, reduce the occurrence of cardiovascular disease and other complications, and ultimately reduce the mortality of patients post PCI. CONCLUSION The application of IBPM contributed to reduce the occurrence of complications, shorten the time of vascular reperfusion, and guide treatment of clinicians in time.
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Affiliation(s)
- Yang Jiang
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Junying Liu
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Wanzhong Peng
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Aili Wang
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Lina Guo
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Zesheng Xu
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China.
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Xie J, Cheng Z, Gu L, Wu B, Zhang G, Shiu W, Chen R, Wang Z, Liu C, Tu J, Cai X, Liu J, Zhang Z. Evaluation of cerebrovascular hemodynamics in vascular dementia patients with a new individual computational fluid dynamics algorithm. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 213:106497. [PMID: 34749243 DOI: 10.1016/j.cmpb.2021.106497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cerebral hemodynamic disorders are involved in the occurrence and progression of vascular dementia (VaD), but the methods to detect hemodynamics remainmultifarious and uncertain nowadays. We aim to exploit a computational fluid dynamics (CFD) approach by static and dynamic parameters, which can be used to detect individual cerebrovascular hemodynamics quantitatively. METHODS A patient-specific CFD model was constructed with geometrical arteries on the magnetic resonance angiography (MRA) and hemodynamic parameters on ultrasound Doppler, by which, the structural and simulated hemodynamic indexes could be obtained, mainly including the cerebral arterial volume (CAV), the number of visible arterial outlets, the total cerebral blood flow (tCBF) index and the total cerebrovascular resistance (tCVR) index. The hemodynamics were detected in subcortical vascular dementia (SVaD) patients (n = 38) and cognitive normal controls (CNCs; n = 40). RESULTS Compared with CNCs, the SVaD patients had reduced outlets, CAV and tCBF index (all P ≤ 0.001), increased volume of white matter hyperintensity (WMH) and tCVR index (both P ≤ 0.01). The fewer outlets (OR = 0.77), higher Hachinski ischemic score (HIS) (OR = 3.65), increased tCVR index (OR = 1.98) and volume of WMH (OR = 1.12) were independently associated with SVaD. All hemodynamic parameters could differentiate the SVaD patinets and CNCs, especially the composite index calculated by outlets, tCVR index and HIS (AUC = 0.943). Fewer outlets and more WMH increased the odds of SVaD, which were partly mediated by the tCBF index (14.4% and 13.0%, respectively). CONCLUSION The reduced outlets, higher HIS and tCVR index may be independent risk factors for the SVaD, and a combination of these indexes can differentiate SVaD patients and CNCs reliably. The tCBF index potentially mediates the relationships between hemodynamic indexes and SVaD. Although all simulated indexes only represented the true hemodynamics indirectly, this CFD model can provide patient-specific hemodynamic alterations non-invasively and conveniently.
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Affiliation(s)
- Jian Xie
- Department of Neurology, Key Laboratory of Developmental Genes and Human Disease, Affiliated ZhongDa Hospital, School of Medicine, Institution of Neuropsychiatry, Southeast University, Nanjing, Jiangsu 210009, China
| | - Zaiheng Cheng
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
| | - Lihua Gu
- Department of Neurology, Key Laboratory of Developmental Genes and Human Disease, Affiliated ZhongDa Hospital, School of Medicine, Institution of Neuropsychiatry, Southeast University, Nanjing, Jiangsu 210009, China
| | - Bokai Wu
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
| | - Gaojia Zhang
- Department of Neurology, Key Laboratory of Developmental Genes and Human Disease, Affiliated ZhongDa Hospital, School of Medicine, Institution of Neuropsychiatry, Southeast University, Nanjing, Jiangsu 210009, China
| | - Wenshin Shiu
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
| | - Rongliang Chen
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
| | - Zan Wang
- Department of Neurology, Key Laboratory of Developmental Genes and Human Disease, Affiliated ZhongDa Hospital, School of Medicine, Institution of Neuropsychiatry, Southeast University, Nanjing, Jiangsu 210009, China
| | - Chang Liu
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
| | - Jie Tu
- The Brain Cognition and Brain Disease institute of Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
| | - Xiaochuan Cai
- Department of Computer Science, University of Colorado Boulder, United States
| | - Jia Liu
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Zhijun Zhang
- Department of Neurology, Key Laboratory of Developmental Genes and Human Disease, Affiliated ZhongDa Hospital, School of Medicine, Institution of Neuropsychiatry, Southeast University, Nanjing, Jiangsu 210009, China; The Brain Cognition and Brain Disease institute of Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China; Research Center for Brain Health, Pazhou Lab, Guangzhou, Guangdong 510330, China.
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Smith CK, Ashley AL, Zhu X, Cushing AC. Agreement between oscillometric and direct blood pressure measurements in anesthetized captive chimpanzees (Pan troglodytes). Am J Vet Res 2021; 82:963-969. [PMID: 34727067 DOI: 10.2460/ajvr.20.11.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the level of agreement (LOA) between direct and oscillometric blood pressure (BP) measurements and the ability of oscillometric measurements to accurately detect hypotension in anesthetized chimpanzees (Pan troglodytes). ANIMALS 8 captive, adult chimpanzees. PROCEDURES During prescheduled annual examinations, each chimpanzee underwent general anesthesia and patient monitoring for their examination, echocardiography for a concurrent study, and measurement of direct BP with the use of tibial artery catheterization and oscillometry with the use of a cuff placed around a brachium and a cuff placed around the second digit of the contralateral forelimb for the present study. Bland-Altman plots were generated to compare results for direct and oscillometric BP measurements. Mean bias and 95% LOAs were calculated for oscillometric measurements of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) for each cuff site. Sensitivity and specificity in detecting hypotension were also determined for each cuff site. RESULTS There were 74 paired direct and brachial oscillometric measurements of each, SAP, MAP, and DAP and 66 paired direct and digit oscillometric measurements of each, SAP, MAP, and DAP. Only brachial oscillometric measurements of MAP had adequate sensitivity (78%) and specificity (95%) to accurately detect hypotension, and this technique also had the least mean bias (0.8 mm Hg; 95% LOA, -29 to 31 mm Hg). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that brachial oscillometric measurement of MAP provided reasonable agreement with tibial arterial direct MAP measurement and performed well in diagnosing hypotension in anesthetized chimpanzees.
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Affiliation(s)
- Christopher K Smith
- From the Department of Small Animal Clinical Sciences (Smith, Cushing) and Office of Information and Technology (Zhu), College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996; and The Chattanooga Zoo, Chattanooga, TN 37404 (Ashley)
| | - Anthony L Ashley
- From the Department of Small Animal Clinical Sciences (Smith, Cushing) and Office of Information and Technology (Zhu), College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996; and The Chattanooga Zoo, Chattanooga, TN 37404 (Ashley)
| | - Xiaojuan Zhu
- From the Department of Small Animal Clinical Sciences (Smith, Cushing) and Office of Information and Technology (Zhu), College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996; and The Chattanooga Zoo, Chattanooga, TN 37404 (Ashley)
| | - Andrew C Cushing
- From the Department of Small Animal Clinical Sciences (Smith, Cushing) and Office of Information and Technology (Zhu), College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996; and The Chattanooga Zoo, Chattanooga, TN 37404 (Ashley)
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063-e1143. [PMID: 34605781 DOI: 10.1097/ccm.0000000000005337] [Citation(s) in RCA: 831] [Impact Index Per Article: 277.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Jo G, Yang TH, Koo JH, Jun MH, Kim YM. A Transfer Function Model Development for Reconstructing Radial Pulse Pressure Waveforms Using Non-Invasively Measured Pulses by a Robotic Tonometry System. SENSORS 2021; 21:s21206837. [PMID: 34696048 PMCID: PMC8540787 DOI: 10.3390/s21206837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 12/03/2022]
Abstract
The primary goal of this study is to develop a mathematical model that can establish a transfer function relationship between the “external” pulse pressures measured by a tonometer and the “internal” pulse pressure in the artery. The purpose of the model is to accurately estimate and rebuild the internal pulse pressure waveforms using arterial tonometry measurements. To develop and validate a model without human subjects and operators for consistency, this study employs a radial pulse generation system, a robotic tonometry system, and a write model with an artificial skin and vessel. A transfer function model is developed using the results of the pulse testing and the mechanical characterization testing of the skin and vessel. To evaluate the model, the pulse waveforms are first reconstructed for various reference pulses using the model with tonometry data. They are then compared with pulse waveforms acquired by internal measurement (by the built-in pressure sensor in the vessel) the external measurement (the on-skin measurement by the robotic tonometry system). The results show that the model-produced pulse waveforms coinciding well with the internal pulse waveforms with small relative errors, indicating the effectiveness of the model in reproducing the actual pulse pressures inside the vessel.
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Affiliation(s)
- Gwanghyun Jo
- Department of Mathematics, Kunsan National University, 558 Daehak-ro, Gunsan-si 54150, Korea;
| | - Tae-Heon Yang
- Department of Electronic Engineering, Korea National University of Transportation, 50 Daehak-ro, Chungju-si 27469, Korea
- Correspondence: (T.-H.Y.); (Y.-M.K.)
| | - Jeong-Hoi Koo
- Department of Mechanical and Manufacturing Engineering, Miami University, Oxford, OH 45242, USA;
| | - Min-Ho Jun
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672, Yuseong-daero, Yuseong-gu, Daejeon 34054, Korea;
| | - Young-Min Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672, Yuseong-daero, Yuseong-gu, Daejeon 34054, Korea;
- Correspondence: (T.-H.Y.); (Y.-M.K.)
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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181-1247. [PMID: 34599691 PMCID: PMC8486643 DOI: 10.1007/s00134-021-06506-y] [Citation(s) in RCA: 1328] [Impact Index Per Article: 442.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Rhodes
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Flávia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Hospital of São Paulo, São Paulo, Brazil
| | | | | | - Hallie C Prescott
- University of Michigan and VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | | | - Steven Simpson
- University of Kansas Medical Center, Kansas City, KS, USA
| | - W Joost Wiersinga
- ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, Emirates University, Al Ain, United Arab Emirates
| | - Derek C Angus
- University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA
| | - Yaseen Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Luciano Azevedo
- School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Lisa Burry
- Mount Sinai Hospital & University of Toronto (Leslie Dan Faculty of Pharmacy), Toronto, ON, Canada
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - John Centofanti
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Angel Coz Yataco
- Lexington Veterans Affairs Medical Center/University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Kent Doi
- The University of Tokyo, Tokyo, Japan
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Shevin Jacob
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Klompas
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Younsuck Koh
- ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Anand Kumar
- University of Manitoba, Winnipeg, MB, Canada
| | - Arthur Kwizera
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzana Lobo
- Intensive Care Division, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Henry Masur
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | | | | | - Yatin Mehta
- Medanta the Medicity, Gurugram, Haryana, India
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Nunnally
- New York University School of Medicine, New York, NY, USA
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tiffany Osborn
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Michael Puskarich
- University of Minnesota/Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jason Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | | | | | | | - Charles L Sprung
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tobias Welte
- Medizinische Hochschule Hannover and German Center of Lung Research (DZL), Hannover, Germany
| | - Janice Zimmerman
- World Federation of Intensive and Critical Care, Brussels, Belgium
| | - Mitchell Levy
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island & Rhode Island Hospital, Providence, RI, USA
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Zhou B, Lin LY, Liu XA, Ling YS, Zhang YY, Luo AQ, Wu MC, Guo RM, Chen HL, Guo Q. Invasive Blood Pressure Measurement and In-hospital Mortality in Critically Ill Patients With Hypertension. Front Cardiovasc Med 2021; 8:720605. [PMID: 34540920 PMCID: PMC8440864 DOI: 10.3389/fcvm.2021.720605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Invasive blood pressure (IBP) measurement is common in the intensive care unit, although its association with in-hospital mortality in critically ill patients with hypertension is poorly understood. Methods and Results: A total of 11,732 critically ill patients with hypertension from the eICU-Collaborative Research Database (eICU-CRD) were enrolled. Patients were divided into 2 groups according to whether they received IBP. The primary outcome in this study was in-hospital mortality. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) models were used to balance the confounding covariates. Multivariable logistic regression was used to evaluate the association between IBP measurement and hospital mortality. The IBP group had a higher in-hospital mortality rate than the no IBP group in the primary cohort [238 (8.7%) vs. 581 (6.5%), p < 0.001]. In the PSM cohort, the IBP group had a lower in-hospital mortality rate than the no IBP group [187 (8.0%) vs. 241 (10.3%), p = 0.006]. IBP measurement was associated with lower in-hospital mortality in the PSM cohort (odds ratio, 0.73, 95% confidence interval, 0.59–0.92) and in the IPTW cohort (odds ratio, 0.81, 95% confidence interval, 0.67–0.99). Sensitivity analyses showed similar results in the subgroups with high body mass index and no sepsis. Conclusions: In conclusion, IBP measurement was associated with lower in-hospital mortality in critically ill patients with hypertension, highlighting the importance of IBP measurement in the intensive care unit.
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Affiliation(s)
- Bin Zhou
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liang-Ying Lin
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Ai Liu
- Institute of Nursing, Guangdong Food and Drug Vocational College, Guangzhou, China
| | - Ye-Sheng Ling
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuan-Yuan Zhang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - An-Qi Luo
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng-Chun Wu
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruo-Mi Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hua-Li Chen
- Department of Nosocomial Infection Control, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qi Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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35
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Liu J, Yan B, Chen SC, Zhang YT, Sodini C, Zhao N. Non-Invasive Capillary Blood Pressure Measurement Enabling Early Detection and Classification of Venous Congestion. IEEE J Biomed Health Inform 2021; 25:2877-2886. [PMID: 33513121 DOI: 10.1109/jbhi.2021.3055760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Capillary blood pressure (CBP) is the primary driving force for fluid exchange across microvessels. Subclinical systemic venous congestion prior to overt peripheral edema can directly result in elevated peripheral CBP. Therefore, CBP measurements can enable timely edema control in a variety of clinical cases including venous insufficiency, heart failure and so on. However, currently CBP measurements can be only done invasively and with a complicated experimental setup. In this work, we proposed an opto-mechanical system to achieve non-invasive and automatic CBP measurements through modifying the widely implemented oscillometric technique in home-use arterial blood pressure monitors. The proposed CBP system is featured with a blue light photoplethysmography sensor embedded in finger/toe cuffs to probe skin capillary pulsations. The experimental results demonstrated the proposed CBP system can track local CBP changes induced by different levels of venous congestion. Leveraging the decision tree technique, we demonstrate the use of a multi-site CBP measurement at fingertips and toes to classify four categories of subjects (total N = 40) including patients with peripheral arterial disease, varicose veins and heart failure. Our work demonstrates the promising non-invasive CBP measurement as well as its great potential in realizing point-of-care systems for the management of cardiovascular diseases.
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36
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Imputation of the continuous arterial line blood pressure waveform from non-invasive measurements using deep learning. Sci Rep 2021; 11:15755. [PMID: 34344934 PMCID: PMC8333060 DOI: 10.1038/s41598-021-94913-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
In two-thirds of intensive care unit (ICU) patients and 90% of surgical patients, arterial blood pressure (ABP) is monitored non-invasively but intermittently using a blood pressure cuff. Since even a few minutes of hypotension increases the risk of mortality and morbidity, for the remaining (high-risk) patients ABP is measured continuously using invasive devices, and derived values are extracted from the recorded waveforms. However, since invasive monitoring is associated with major complications (infection, bleeding, thrombosis), the ideal ABP monitor should be both non-invasive and continuous. With large volumes of high-fidelity physiological waveforms, it may be possible today to impute a physiological waveform from other available signals. Currently, the state-of-the-art approaches for ABP imputation only aim at intermittent systolic and diastolic blood pressure imputation, and there is no method that imputes the continuous ABP waveform. Here, we developed a novel approach to impute the continuous ABP waveform non-invasively using two continuously-monitored waveforms that are currently part of the standard-of-care, the electrocardiogram (ECG) and photo-plethysmogram (PPG), by adapting a deep learning architecture designed for image segmentation. Using over 150,000 min of data collected at two separate health systems from 463 patients, we demonstrate that our model provides a highly accurate prediction of the continuous ABP waveform (root mean square error 5.823 (95% CI 5.806–5.840) mmHg), as well as the derived systolic (mean difference 2.398 ± 5.623 mmHg) and diastolic blood pressure (mean difference − 2.497 ± 3.785 mmHg) compared to arterial line measurements. Our approach can potentially be used to measure blood pressure continuously and non-invasively for all patients in the acute care setting, without the need for any additional instrumentation beyond the current standard-of-care.
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37
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Ranjit S, Natraj R, Kissoon N, Thiagarajan RR, Ramakrishnan B, Monge García MI. Variability in the Hemodynamic Response to Fluid Bolus in Pediatric Septic Shock. Pediatr Crit Care Med 2021; 22:e448-e458. [PMID: 33750093 DOI: 10.1097/pcc.0000000000002714] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fluid boluses are commonly administered to improve the cardiac output and tissue oxygen delivery in pediatric septic shock. The objective of this study is to evaluate the effect of an early fluid bolus administered to children with septic shock on the cardiac index and mean arterial pressure, as well as on the hemodynamic response and its relationship with outcome. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS We prospectively collected hemodynamic data from children with septic shock presenting to the emergency department or the PICU who received a fluid bolus (10 mL/kg of Ringers Lactate over 30 min). A clinically significant response in cardiac index-responder and mean arterial pressure-responder was both defined as an increase of greater than or equal to 10% 10 minutes after fluid bolus. MEASUREMENTS AND MAIN RESULTS Forty-two children with septic shock, 1 month to 16 years old, median Pediatric Risk of Mortality-III of 13 (interquartile range, 9-19), of whom 66% were hypotensive and received fluid bolus within the first hour of shock recognition. Cardiac index- and mean arterial pressure-responsiveness rates were 31% and 38%, respectively. We failed to identify any association between cardiac index and mean arterial pressure changes (r = 0.203; p = 0.196). Cardiac function was similar in mean arterial pressure- and cardiac index-responders and nonresponders. Mean arterial pressure-responders increased systolic, diastolic, and perfusion pressures (mean arterial pressure - central venous pressure) after fluid bolus due to higher indexed systemic vascular resistance and arterial elastance index. Mean arterial pressure-nonresponders required greater vasoactive-inotrope support and had higher mortality. CONCLUSIONS The hemodynamic response to fluid bolus in pediatric septic shock was variable and unpredictable. We failed to find a relationship between mean arterial pressure and cardiac index changes. The adverse effects of fluid bolus extended beyond fluid overload and, in some cases, was associated with reduced mean arterial pressure, perfusion pressures and higher vasoactive support. Mean arterial pressure-nonresponders had increased mortality. The response to the initial fluid bolus may be helpful to understand each patient's individualized physiologic response and guide continued hemodynamic management.
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Affiliation(s)
| | | | - Niranjan Kissoon
- The University of British Columbia, The Child and Family Research Institute, and BC Children's Hospital, Vancouver, BC, Canada
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - M Ignacio Monge García
- Servicio de Cuidados Críticos y Urgencias Hospital SAS de Jerez C/Circunvalación s/n, Jerez de la Frontera, Spain
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38
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Saab R, Wu BP, Rivas E, Chiu A, Lozovoskiy S, Ma C, Yang D, Turan A, Sessler DI. Failure to detect ward hypoxaemia and hypotension: contributions of insufficient assessment frequency and patient arousal during nursing assessments. Br J Anaesth 2021; 127:760-768. [PMID: 34301400 DOI: 10.1016/j.bja.2021.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Postoperative hypotension and hypoxaemia are common and often unrecognised. With intermittent nursing vital signs, hypotensive or hypoxaemic episodes might be missed because they occur between scheduled measurements, or because the process of taking vital signs arouses patients and temporarily improves arterial blood pressure and ventilation. We therefore estimated the fraction of desaturation and hypotension episodes that did not overlap nursing assessments and would therefore usually be missed. We also evaluated the effect of taking vital signs on blood pressure and oxygen saturation. METHODS We estimated the fraction of desaturated episodes (arterial oxygen saturation <90% for at least 90% of the time within 30 continuous minutes) and hypotensive episodes (MAP <70 mm Hg for 15 continuous minutes) that did not overlap nursing assessments in patients recovering from noncardiac surgery. We also evaluated changes over time before and after nursing visits. RESULTS Among 782 patients, we identified 878 hypotensive episodes and 2893 desaturation episodes, of which 79% of the hypotensive episodes and 82% of the desaturation episodes did not occur within 10 min of a nursing assessment and would therefore usually be missed. Mean BP and oxygen saturation did not improve by clinically meaningful amounts during nursing vital sign assessments. CONCLUSIONS Hypotensive and desaturation episodes are mostly missed because vital sign assessments on surgical wards are sparse, rather than being falsely negative because the assessment process itself increases blood pressure and oxygen saturation. Continuous vital sign monitoring will detect more disturbances, potentially giving clinicians time to intervene before critical events occur.
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Affiliation(s)
- Remie Saab
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Bernie P Wu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Eva Rivas
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Anesthesia, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Andrew Chiu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Sofia Lozovoskiy
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Chao Ma
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Dongsheng Yang
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
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Agreement Between Non-Invasive (Oscillatory) and Invasive Intra-Arterial Blood Pressure in the Pediatric Cardiac Critical Care Unit. Indian Pediatr 2021. [PMID: 33772534 DOI: 10.1007/s13312-021-2260-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Herrera FC, Siaron KB, Stutzman SE, Wilson J, Olson D. Exploring the accuracy and precision of BP measurements. Nursing 2021; 51:47-50. [PMID: 34157002 DOI: 10.1097/01.nurse.0000751336.84200.7a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Accurate and precise BP measurements are crucial to clinical decision-making and interventions as healthcare professionals aim to prevent complications from hypertension, yet the literature provides no gold standard for measuring BP. This article discusses the additional research necessary to develop best practices and improve patient outcomes.
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Affiliation(s)
- Fatima Claire Herrera
- At Texas Woman's University in Dallas, Tex., Fatima Claire Herrera is a nursing student and Jennifer Wilson is a clinical professor. At the University of Texas Southwestern Medical Center in Dallas, Tex., Kathrina B. Siaron is a neuroscience ICU nurse, Sonja E. Stutzman is a clinical research manager, and DaiWai Olson is a professor of neurology
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Accuracy of oscillometric blood pressure measurement at both arms in the lateral position. Blood Press Monit 2021; 26:364-372. [PMID: 34001758 DOI: 10.1097/mbp.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the accuracy of noninvasive blood pressure (NIBP) measurement at the dependent- and nondependent arms in the lateral position, using invasive blood pressure (IBP) as reference. METHODS This prospective observational study included 42 adult patients undergoing surgery in the lateral position. Paired readings of IBP and NIBP were obtained at either arm. The accuracy of both arms in detecting mean arterial pressure (MAP) <70 mmHg was evaluated using the area under the receiver operating characteristic curve (AUC). The agreement between the IBP and NIBP was evaluated using the Bland-Altman and error grid analyses. RESULTS We analyzed 350 and 347 paired readings at the dependent- and nondependent arms. The AUC for detecting hypotension was comparable in both arms. The negative and positive predictive values (95% confidence interval) were 100% (99-100%) and 24% (14-34%), respectively for the dependent arm at cutoff value MAP ≤86 mmHg; and were 99% (96-100%) and 21% (13-30%), respectively for the nondependent arm at cutoff value MAP ≤75 mmHg. The mean bias for MAP was -6.0 ± 9.1 and 6.3 ± 10.1 mmHg; and for systolic blood pressure was 0.3 ± 11.6 and 13.2 ± 12.6 mmHg, in the dependent- and nondependent arm, respectively. Error grid analysis showed that the proportions of paired MAP readings in risk zone A were 71 and 82% in the dependent- and the nondependent arms, respectively. CONCLUSION In the lateral position, the NIBP readings at both arms are not interchangeable with the corresponding IBP readings. However, NIBP measurement at both arms can be used to accurately rule out hypotension.
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Zhang Y, Lan L, Qi H, Qin J, Ren L, Li L, Yan Y, Gan S, Xiang B. Intra-arterial versus oscillometric blood pressure measurements in women with severe peripartum hypertension undergoing urgent treatment with nicardipine: An observational study. Pregnancy Hypertens 2021; 24:100-106. [PMID: 33773326 DOI: 10.1016/j.preghy.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare radial arterial catheter-derived pressure with oscillometric blood pressure in women with severe peripartum hypertension undergoing urgent treatment with intravenous nicardipine at a maternal intensive care unit. STUDY DESIGN We obtained patients' paired values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). All of the measurements were divided into four groups based on the levels of SBP and MAP measured using the oscillometric method. MAIN OUTCOME MEASURES We assessed agreements of the paired values using the Bland-Altman method. The clinical relevance of differences between the two methods was assessed by error grid analysis. RESULTS A total of 337 paired SBP and DBP values and 305 paired MAP values were obtained for 89 patients. The values of intra-arterial SBP were higher than those of oscillometric SBP. The values of intra-arterial MAP were higher than those of oscillometric MAP except for the women with MAP ≥ 125 mm Hg. Bland - Altman analysis showed acceptable agreement for DBP and MAP measured by intra-arterial method and oscillometric method. Error grid analysis showed the proportions of measurements in risk zones A to E were 83.22%, 16.46%, 0.32%, 0%, and 0% for SBP, and 97.81%, 2.19%, 0%, 0%, and 0% for MAP, respectively. CONCLUSION Intra-arterial MAP can be used reliably to monitor the effect of intravenous nicardipine for treating severe hypertension. Intra-arterial SBP may trigger moderate-risk treatment decisions in the women with oscillometric SBP ≤ 160 mm Hg.
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Affiliation(s)
- Yaozong Zhang
- Department of Intensive Care Medicine, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China.
| | - Lan Lan
- Department of Intensive Care Medicine, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China
| | - Haifeng Qi
- Department of Intensive Care Medicine, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China
| | - Jiali Qin
- Department of Intensive Care Medicine, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China
| | - Li Ren
- Department of Emergency, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China
| | - Lan Li
- Department of Intensive Care Medicine, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China
| | - Yunsheng Yan
- Department of Intensive Care Medicine, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China
| | - Shengwen Gan
- Department of Intensive Care Medicine, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China
| | - Bingxin Xiang
- Department of Intensive Care Medicine, Chongqing Health Centre for Women and Children, Chongqing, 120 Longshan Road, Chongqing 400013, China
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44
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Boonya-ananta T, Rodriguez AJ, Ajmal A, Du Le VN, Hansen AK, Hutcheson JD, Ramella-Roman JC. Synthetic photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to body mass index (BMI). Sci Rep 2021; 11:2570. [PMID: 33510428 PMCID: PMC7843978 DOI: 10.1038/s41598-021-82124-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/14/2021] [Indexed: 01/30/2023] Open
Abstract
Cardiovascular disease is one of the leading causes of death in the United States and obesity significantly increases the risk of cardiovascular disease. The measurement of blood pressure (BP) is critical in monitoring and managing cardiovascular disease hence new wearable devices are being developed to make BP more accessible to physicians and patients. Several wearables utilize photoplethysmography from the wrist vasculature to derive BP assessment although many of these devices are still at the experimental stage. With the ultimate goal of supporting instrument development, we have developed a model of the photoplethysmographic waveform derived from the radial artery at the volar surface of the wrist. To do so we have utilized the relation between vessel biomechanics through Finite Element Method and Monte Carlo light transport model. The model shows similar features to that seen in PPG waveform captured using an off the shelf device. We observe the influence of body mass index on the PPG signal. A degradation the PPG signal of up to 40% in AC to DC signal ratio was thus observed.
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Affiliation(s)
- Tananant Boonya-ananta
- grid.65456.340000 0001 2110 1845Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL 33174 USA
| | - Andres J. Rodriguez
- grid.65456.340000 0001 2110 1845Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL 33174 USA
| | - Ajmal Ajmal
- grid.65456.340000 0001 2110 1845Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL 33174 USA
| | - Vinh Nguyen Du Le
- grid.65456.340000 0001 2110 1845Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL 33174 USA
| | - Anders K. Hansen
- grid.5170.30000 0001 2181 8870Department of Photonics Engineering, Technical University of Denmark, Frederiksborgvej 399, 4000 Roskilde, Denmark
| | - Joshua D. Hutcheson
- grid.65456.340000 0001 2110 1845Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL 33174 USA
| | - Jessica C. Ramella-Roman
- grid.65456.340000 0001 2110 1845Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL 33174 USA ,grid.65456.340000 0001 2110 1845Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL 33199 USA
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Peng Y, Zhou J, Song X, Pang K, Samy A, Hao Z, Wang J. A Flexible Pressure Sensor with Ink Printed Porous Graphene for Continuous Cardiovascular Status Monitoring. SENSORS (BASEL, SWITZERLAND) 2021; 21:E485. [PMID: 33445532 PMCID: PMC7828094 DOI: 10.3390/s21020485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 01/01/2023]
Abstract
Flexible electronics with continuous monitoring ability a extensively preferred in various medical applications. In this work, a flexible pressure sensor based on porous graphene (PG) is proposed for continuous cardiovascular status monitoring. The whole sensor is fabricated in situ by ink printing technology, which grants it the potential for large-scale manufacture. Moreover, to enhance its long-term usage ability, a polyethylene terephthalate/polyethylene vinylacetate (PET/EVA)-laminated film is employed to protect the sensor from unexpected shear forces on the skin surface. The sensor exhibits great sensitivity (53.99/MPa), high resolution (less than 0.3 kPa), wide detecting range (0.3 kPa to 1 MPa), desirable robustness, and excellent repeatability (1000 cycles). With the assistance of the proposed pressure sensor, vital cardiovascular conditions can be accurately monitored, including heart rate, respiration rate, pulse wave velocity, and blood pressure. Compared to other sensors based on self-supporting 2D materials, this sensor can endure more complex environments and has enormous application potential for the medical community.
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Affiliation(s)
- Yuxin Peng
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China; (Y.P.); (J.Z.); (Z.H.); (J.W.)
| | - Jingzhi Zhou
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China; (Y.P.); (J.Z.); (Z.H.); (J.W.)
| | - Xian Song
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China; (Y.P.); (J.Z.); (Z.H.); (J.W.)
| | - Kai Pang
- Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China;
| | - Akram Samy
- Department of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310058, China;
| | - Zengming Hao
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China; (Y.P.); (J.Z.); (Z.H.); (J.W.)
| | - Jian Wang
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China; (Y.P.); (J.Z.); (Z.H.); (J.W.)
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Juri T, Suehiro K, Uchimoto A, Go H, Fujimoto Y, Mori T, Nishikawa K. Error grid analysis for risk management in the difference between invasive and noninvasive blood pressure measurements. J Anesth 2021; 35:189-196. [PMID: 33427971 DOI: 10.1007/s00540-020-02893-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 12/27/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Invasive arterial blood pressure (IAP) and noninvasive blood pressure (NIBP) measurements are both common methods. Recently, a new method of error grid analysis was proposed to compare blood pressure obtained using two measurement methods. This study aimed to compare IAP and NIBP measurements using the error grid analysis and investigate potential confounding factors affecting the discrepancies between IAP and NIBP. METHODS Adult patients who underwent general anesthesia in the supine position with both IAP and NIBP measurements were retrospectively investigated. The error grid analyses were performed to compare IAP and NIBP. In the error grid analysis, the clinical relevance of the discrepancies between IAP and NIBP was evaluated and classified into five zones from no risk (A) to dangerous risk (E). RESULTS Overall, data of 1934 IAP/NIBP measurement pairs from 100 patients were collected. The error grid analysis revealed that the proportions of zones A-E for systolic blood pressure were 96.4%, 3.5%, 0.05%, 0%, and 0%, respectively. In contrast, the proportions for mean blood pressure were 82.5%, 16.7%, 0.8%, 0%, and 0%, respectively. The multiple regression analysis revealed that continuous phenylephrine administration (p = 0.016) and age (p = 0.044) were the significant factors of an increased clinical risk of the differences in mean blood pressure. CONCLUSIONS The error grid analysis indicated that the differences between IAP and NIBP for mean blood pressure were not clinically acceptable and had the risk of leading to unnecessary treatments. Continuous phenylephrine administration and age were the significant factors of an increased clinical risk of the discrepancies between IAP and NIBP.
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Affiliation(s)
- Takashi Juri
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan
| | - Koichi Suehiro
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan.
| | - Akihiro Uchimoto
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan
| | - Hirofumi Go
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yohei Fujimoto
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan
| | - Takashi Mori
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan
| | - Kiyonobu Nishikawa
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan
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Lin WH, Chen F, Geng Y, Ji N, Fang P, Li G. Towards accurate estimation of cuffless and continuous blood pressure using multi-order derivative and multivariate photoplethysmogram features. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maximous S, Brotherton BJ, Achilleos A, Akrami KM, Barros LM, Cobb N, Misango D, Papali A, Park C, Shetty VU, Schultz MJ, Taran S, Lee BW. Pragmatic Recommendations for the Management of COVID-19 Patients with Shock in Low- and Middle-Income Countries. Am J Trop Med Hyg 2020; 104:72-86. [PMID: 33350378 PMCID: PMC7957233 DOI: 10.4269/ajtmh.20-1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022] Open
Abstract
As some patients infected with the novel coronavirus progress to critical illness, a subset will eventually develop shock. High-quality data on management of these patients are scarce, and further investigation will provide valuable information in the context of the pandemic. A group of experts identify a set of pragmatic recommendations for the care of patients with SARS-CoV-2 and shock in resource-limited environments. We define shock as life-threatening circulatory failure that results in inadequate tissue perfusion and cellular dysoxia/hypoxia, and suggest that it can be operationalized via clinical observations. We suggest a thorough evaluation for other potential causes of shock and suggest against indiscriminate testing for coinfections. We suggest the use of the quick Sequential Organ Failure Assessment (qSOFA) as a simple bedside prognostic score for COVID-19 patients and point-of-care ultrasound (POCUS) to evaluate the etiology of shock. Regarding fluid therapy for the treatment of COVID-19 patients with shock in low-middle-income countries, we favor balanced crystalloids and recommend using a conservative fluid strategy for resuscitation. Where available and not prohibited by cost, we recommend using norepinephrine, given its safety profile. We favor avoiding the routine use of central venous or arterial catheters, where availability and costs are strong considerations. We also recommend using low-dose corticosteroids in patients with refractory shock. In addressing targets of resuscitation, we recommend the use of simple bedside parameters such as capillary refill time and suggest that POCUS be used to assess the need for further fluid resuscitation, if available.
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Affiliation(s)
- Stephanie Maximous
- 1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Brian Jason Brotherton
- 2Department of Internal Medicine, Kijabe Medical Center, Kijabe, Kenya.,3Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Achilleos
- 4Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Kevan M Akrami
- 5Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,6Divisions of Infectious Disease and Critical Care Medicine, University of California San Diego, San Diego, California
| | - Lia M Barros
- 7Department of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Natalie Cobb
- 8Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, Washington
| | - David Misango
- 9Department of Anaesthesiology and Critical Care Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Alfred Papali
- 10Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - Casey Park
- 11Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada
| | - Varun U Shetty
- 3Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marcus J Schultz
- 12Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,13Nuffield Department of Medicine, Mahidol University, Bangkok, Thailand.,14Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Shaurya Taran
- 11Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada
| | - Burton W Lee
- 1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,15Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
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Fujii T, Nishiwaki K. Comparing oscillometric noninvasive and invasive intra-arterial blood pressure monitoring in term neonates under general anesthesia: A retrospective study. Paediatr Anaesth 2020; 30:1396-1401. [PMID: 32959496 DOI: 10.1111/pan.14020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/25/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oscillometric noninvasive blood pressure and/or invasive intra-arterial blood pressure are commonly used to measure the systolic, diastolic, and mean components of blood pressure. Agreement between the two methods has been reported in adults, children, and infants, but rarely in neonates, especially under general anesthesia. AIMS This retrospective study compared the agreement of each measured blood pressure value (oscillometric noninvasive or invasive intra-arterial blood pressure monitoring) in term neonates under general anesthesia. METHODS Data were collected from neonates born at ≥36 weeks of gestation whose body weight was ≥2500 g and who underwent abdominal or noncardiac thoracic surgery with both oscillometric noninvasive and invasive intra-arterial blood pressure measurements from January 2015 to March 2020. The primary outcome was the agreement of systolic, diastolic, and mean blood pressure values between the two methods using Bland-Altman analysis. RESULTS Paired blood pressure measurements (n = 1193) from 67 cases were compared. In Bland-Altman analysis, bias (standard deviation), 95% limits of agreement, and percentage error were -9.3 (8.4), -26.1-7.6, and 26.9% for systolic; 1.6 (6.5), -11.3-14.6, and 38.7% for diastolic; and -1.3 (5.8), -13.0-10.3, and 26.9% for mean blood pressure, respectively. During low blood pressure (intra-arterial mean blood pressure ≤30 mm Hg), the biases (standard deviation) of systolic, diastolic, and mean blood pressure were -11.4 (5.7), -0.7 (3.7), and -5.1 (4.2), whereas during high blood pressure (intra-arterial mean blood pressure ≥60 mm Hg), the values were 0.1 (9.7), 5.6 (9.4), and 6.4 (7.4), respectively. CONCLUSIONS Based on the bias and percentage error, the mean blood pressure exhibited the most acceptable agreement between oscillometric noninvasive and invasive intra-arterial blood pressure monitoring in term neonates under general anesthesia. However, during hypertension or hypotension, there was a large discrepancy between the two methods.
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Affiliation(s)
- Tasuku Fujii
- Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery. Anesthesiology 2020; 133:997-1006. [PMID: 33048167 DOI: 10.1097/aln.0000000000003472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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
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