Blood pressure variability as an indicator of sepsis severity in adult emergency department patients - 19/04/18
, Scott R. Millis, PhD b, Jonathon Ottolini, BA a, John M. Wilburn, MD a, Robert L. Sherwin, MD a, James H. Paxton, MD, MBA aAbstract |
Study objective |
Quantify the correlation between blood pressure variability (BPV) and markers of illness severity: serum lactate (LAC) or Sequential Organ Failure Assessment (SOFA) scores.
Methods |
We performed a secondary analysis of data from a prospective, observational study evaluating fluid resuscitation on adult, septic, ED patients. Vital signs and fluid infusion volumes were recorded every 15min during the 3h following ED arrival. BPV was assessed via average real variability (ARV): the average of the absolute differences between consecutive BP measurements. ARV was calculated for the time periods before and after 3 fluid infusion milestones: 10-, 20-, and 30-mL/kg total body weight (TBW). Spearman's rho correlation coefficient analysis was utilized. A p-value<0.05 was considered statistically significant.
Results |
Forty patients were included. Mean fluid infusion was 33.7mL/kg TBW (SD 22.1). All patients received fluid infusion≥10mL/kg TBW, 25 patients received fluid infusion>20mL/kg TBW, and 16 patients received fluid infusion>30mL/kg TBW. Mean initial LAC was 4.0mmol/L (SD 3.2). Mean repeat LAC was 3.1mmol/L (SD 3.2), obtained an average of 6.6h (SD 5.3) later. Mean SOFA score was 7.0 (SD 4.4). BPV correlated with both follow-up LAC (r=0.564; p=0.023) and SOFA score (r=0.544; p=0.024) among the cohort that received a fluid infusion>20-mL/kg TBW.
Conclusion |
With the finding of a positive correlation between BPV and markers of illness severity (LAC and SOFA scores), this pilot study introduces BPV analysis as a real-time, non-invasive tool for continuous sepsis monitoring in the ED.
Le texte complet de cet article est disponible en PDF.Abbreviations : ARV, BP, BPV, HRV, LAC
Keywords : Sepsis, Hemodynamic monitoring, Fluid resuscitation
Plan
| ☆ | Funding: Funding for this study was provided by Wayne State University School of Medicine and Vidacare/Teleflex Corporation. |
| ☆☆ | Conflicts of interests: There are no conflicts of interest for the primary author or any of the co-authors. |
| ★ | Prior abstract publication/presentation: This research has been presented (abstract) at the 2017 meeting for the Society of Critical Care Medicine, Honolulu, Hawaii, on January 23, 2017. |
Vol 36 - N° 4
P. 560-566 - avril 2018 Retour au numéro
Article précédent
- Radiology report “disclaimers” increase the use of abdominal CT in the work-up of pediatric abdominal pain
- Scott M. Alter, Brian Walsh, Patrick J. Lenehan, Richard D. Shih
- Accuracy of bedside point of care testing in critical emergency department patients
- Braden W. McIntosh, Jerina Vasek, Maria Taylor, Deborah Le Blanc, Henry C. Thode, Adam J. Singer
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?