Jamie Palmer
University of Maryland School of Medicine
Baltimore, MD
Disclosure information not submitted.
Matthew Fairchild, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Zain Alam, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Dominique Gelmann, BS
Student
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Katie Andersen, ACNP, BSN, MSN
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center
Baltimore, MD, United States
Disclosure information not submitted.
Zoe Gasparotti, BNS
Nurse
University of Maryland Nedical Center, United States
Disclosure information not submitted.
James Gerding, PA-C
Physician Assistant
University of Maryland Nedical Center, United States
Disclosure information not submitted.
Emily Hart, ACNP-BC
Nurse Practitioner
University Of Maryland /Shock Trauma, Maryland, United States
Disclosure information not submitted.
Katherine Jones, ACNP
Critical Care Resuscitation Unit, Shock Trauma Center
University of Maryland Medical Center, United States
Disclosure information not submitted.
Erin Niles, PA-C
Physician Assistant
R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center, United States
Disclosure information not submitted.
.jpg "Ann Matta, ACNP, , MSN photo")
Ann Matta, ACNP, , MSN
Nurse Practitioner
University of Maryland Medical Center, Maryland, United States
Disclosure information not submitted.
Afrah Ali, MD
Physician
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Kim Boswell, MD (she/her/hers)
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center
Baltimore, MD
Disclosure information not submitted.
Emily Esposito, DO
Attending Physician
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
Ashley Menne, MD, RDCS
MD
U of Maryland Medical Cntr, R. Adams Cowley Shock Trauma Cntr, United States
Disclosure information not submitted.
Daniel Haase, MD, (he/him/his)
Associate Professor of Emergency Medicine and Surgery
R. Adams Cowley Shock Trauma Center
Baltimore, MD
Disclosure information not submitted.
Elizabeth Powell, MD
Assistant Professor of Emergency Medicine
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Jeffrey Rea, MD
MD
R Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
Disclosure information not submitted.
Title: Is Arterial Pressure Monitor Needed in Patients With Acute Aortic Disease: An Observational Study
Introduction: Blood pressure (BP) monitoring and management is essential in the treatment of acute aortic disease (AoD). Current guidelines recommend maintaining systolic BP (SBP) < 120 millimeters of mercury (mmHg). Previous studies had shown differences between invasive arterial BP (IABP) and non-invasive BP monitoring (NIBP) but not whether IABP would change patients’ clinical management. We hypothesized that IABP would change BP management in AoD patients.
Methods: This was a prospective observational study of adult patients with AoD who were admitted to the Critical Care Resuscitation Unit at the University of Maryland Medical Center from 01/2019 – 02/2021. Patients with aortic dissection or aneurysm who had 4 consecutive IABP and NIBP measurements were included. Clinician’s BP management goals were assessed in real time before and after arterial line placement. We defined changes in clinical management as any decreasing/increasing infusion rate, adding a new antihypertensive agent, etc. We used a Bland-Altman plot to identify any systematic differences between IABP and NIBP, and the Classification And Regression Tree (CART) to identify factors with significant association with changes in clinical management. The CART algorithm performed multiple interactions between independent variables to create a decision tree showing factors associated with outcomes. Variables with significant association with BP clinical management were expressed as Relative Variable Importance (RVI) as percentages.
Results: We analyzed 93 patients, 33 (35%) were female. Mean age was 64 years (standard deviation [SD] 14) and 29 (31%) had clinical management change. Mean difference between IABP and NIBP was 11 mmHg (12). Bland Altman plot indicated that IABP values were more frequently ≥ 10 mmHg higher than NIBP values. The most common clinical change, 17/29 or 59% of patients, was increasing antihypertensive infusion. CART identified the most important factors in predicting management change as difference between IABP and NIBP (RVI 100%), followed by highest NIBP SBP (RVI 44%) and IABP SBP (RVI 40%).
Conclusions: SBP by IABP was frequently higher than NIBP resulting in 30% change in clinical management. Clinicians should consider IABP more often in AoD patients with high SBP or lactate concentration.