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.
Richa Beher, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Grace Hollis, n/a
Student
University of Maryland Research Associate Program, United States
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Dominique Gelmann, BS
Student
University of Maryland School of Medicine, United States
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Jamie Palmer
University of Maryland School of Medicine
Baltimore, MD
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Emily Hart, ACNP-BC
Nurse Practitioner
University Of Maryland /Shock Trauma, Maryland, 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
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Ashifa Moledina, ACNP, CCNS, CCRN
Nurse Practitioner
University of Maryland Medical Center, United States
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Nathaniel Woods, BSN, CCRN
Registered Nurse
7The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, Maryland, USA, United States
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Afrah Ali, MD
Physician
University of Maryland School of Medicine, United States
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Kevin Jones, MD, MPH
Physician
University of Maryland R Adams Cowley Shock Trauma Center, United States
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Daniel Haase, MD, (he/him/his)
Associate Professor of Emergency Medicine and Surgery
R. Adams Cowley Shock Trauma Center
Baltimore, MD
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Ashley Menne, MD, RDCS
MD
U of Maryland Medical Cntr, R. Adams Cowley Shock Trauma Cntr, United States
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Elizabeth Powell, MD
Assistant Professor of Emergency Medicine
University of Maryland School of Medicine, United States
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Jeffrey Rea, MD
MD
R Adams Cowley Shock Trauma Center, United States
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Katherine Jones, ACNP
Critical Care Resuscitation Unit, Shock Trauma Center
University of Maryland Medical Center, United States
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William Teeter, MD
Physician
University of Maryland School of Medicine, United States
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Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
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Title: Do Patients With Non-Hypertensive Disease Need Arteria Pressure Monitoring? A Prospective Study
Introduction: Blood Pressure (BP) monitoring is an essential component of care for patients with non-hypertensive diseases. Invasive arterial BP (IABP) is more accurate than non-invasive BP (NIBP) monitoring, though the clinical significance of this difference is unknown and whether IABP is necessary. We hypothesized that the IABP would result in change of clinical management among patients with non-hypertensive disease states.
Methods: This was a prospective observational study including adults with non-hypertensive diseases, who were admitted to the Critical Care Resuscitation Unit at a quaternary academic center from 02/2019-05/2021. We excluded patients with hypertensive emergencies or those without 4 subsequent BP measurements. First, CCRU clinicians’ management according to NIBP values to maintain a mean arterial pressure (MAP) >65 millimeter of mercury (mmHg) were observed and recorded before arterial catheter insertion. Their managements after arterial catheters insertion were again recorded. Changes in clinical management were defined as: a) increasing, b) decreasing or c) adding vs removing a medication/infusion. We performed Classification and Regression Tree (CART), which is a machine learning algorithm, to identify and predict variables with significant associations with change of clinical management. The CART using recursive partition to create a decision tree and assigns significant factors as percentages of Relative Variable Importance (RVI).
Results: We analyzed 188 patients, mean age was 57 (standard deviation 16) years. Eighty (43%) patients had clinical management change, the most common of which was increasing (34%), then adding a new (33%) infusion. MAP for NIBP was 7 mmHg (SD 13) greater than IABP measurements, 65 (35%) patients having a MAP difference of >10 mmHg. The most important variable in predicting management change was arterial MAP (RVI 100%), followed by the [IABP-NIBP] difference (RVI 76%), and Sequential Organ Failure Assessment (SOFA) score (RVI 36%).
Conclusions: IABP measurements, which was frequently lower than NIBP values, resulted in real-time clinical management changes in almost half of non-hypertensive patients arriving at our resuscitation unit. Clinicians should consider IABP monitoring more often in these patients, especially those with high SOFA scores.