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{ "pk": 15386, "title": "Discrepancy Between Invasive and Noninvasive Blood Pressure Measurements in Patients with Sepsis by Vasopressor Status", "subtitle": null, "abstract": "Introduction:\n Blood pressure (BP) monitoring is an essential component of sepsis management. The Surviving Sepsis Guidelines recommend invasive arterial BP (IABP) monitoring, although the benefits over non-invasive BP (NIBP) monitoring are unclear. This study investigated discrepancies between IABP and NIBP measurement and their clinical significance. We hypothesized that IABP monitoring would be associated with changes in management among patients with sepsis requiring vasopressors.\n \nMethods:\n We performed a retrospective study of adult patients admitted to the critical care resuscitation unit at a quaternary medical center between January 1–December 31, 2017. We included patients with sepsis conditions AND IABP monitoring. We defined a clinically significant BP discrepancy (BPD) between NIBP and IABP measurement as a difference of > 10 millimeters of mercury (mm Hg) AND change of BP management to maintain mean arterial pressure ≥ 65 mm Hg.\nResults:\n We analyzed 127 patients. Among 57 (45%) requiring vasopressors, 9 (16%) patients had a clinically significant BPD vs 2 patients (3% odds ratio [OR] 6.4; 95% CI: 1.2-30; P = 0.01) without vasopressors. In multivariable logistic regression, higher Sequential Organ Failure Assessment (SOFA) score (OR 1.33; 95% CI: 1.02-1.73; P = 0.03) and serum lactate (OR 1.27; 95% CI: 1.003-1.60, P = 0.04) were associated with increased likelihood of clinically significant BPD. There were no complications (95% CI: 0-0.02) from arterial catheter insertions.\nConclusion:\n Among our population of septic patients, the use of vasopressors was associated with increased odds of a clinically significant blood pressure discrepancy between IABP and NIBP measurement. Additionally, higher SOFA score and serum lactate were associated with higher likelihood of clinically significant blood pressure discrepancy. Further studies are needed to confirm our observations and investigate the benefits vs the risk of harm of IABP monitoring in patients with sepsis.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "arterial pressure" }, { "word": "blood pressure monitoring" }, { "word": "vascular access devices" }, { "word": "sepsis" }, { "word": "septic shock" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/61w0x67j", "frozenauthors": [ { "first_name": "Quincy", "middle_name": "K.", "last_name": "Tran", "name_suffix": "", "institution": "University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, Maryland", "department": "None" }, { "first_name": "Dominique", "middle_name": "", "last_name": "Gelmann", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Zain", "middle_name": "", "last_name": "Alam", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Richa", "middle_name": "", "last_name": "Beher", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Emily", "middle_name": "", "last_name": "Engelbrecht-Wiggans", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Matthew", "middle_name": "", "last_name": "Fairchild", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Emily", "middle_name": "", "last_name": "Hart", "name_suffix": "", "institution": "University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, Maryland", "department": "None" }, { "first_name": "Grace", "middle_name": "", "last_name": "Hollis", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Allison", "middle_name": "", "last_name": "Karwoski", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Jamie", "middle_name": "", "last_name": "Palmer", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Alison", "middle_name": "", "last_name": "Raffman", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland", "department": "None" }, { "first_name": "Daniel", "middle_name": "J.", "last_name": "Haase", "name_suffix": "", "institution": "University of Maryland School of Medicine", "department": "None" } ], "date_submitted": "2021-05-14T16:49:52+01:00", "date_accepted": "2021-05-14T16:49:52+01:00", "date_published": "2022-05-06T01:26:11+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/15386/galley/7783/download/" } ] }