Comparison of noninvasive blood pressure monitoring with invasive arterial pressure monitoring in medical ICU patients with septic shock

Riley, Leonard; Chen, Guoqing John; Latham, Heath

doi:10.1097/mbp.0000000000000258

Cited by 30 publications

(30 citation statements)

References 15 publications

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“…95,96,133 During the early period of resuscitation, noninvasive blood pressure measurement is reasonable, especially if blood pressure normalizes with fluid or vasopressor administration. [134][135][136][137] Patients with poor or unreliable blood pressure measurements by noninvasive blood pressure cuffs may benefit from arterial catheter placement for blood pressure monitoring and titration of therapy.…”

Section: Vascular Access and Invasive Monitoring Key Pointsmentioning

confidence: 99%

Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report

Yealy¹,

Mohr²,

Shapiro³

et al. 2021

Annals of Emergency Medicine

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Section: Vascular Access and Invasive Monitoring Key Pointsmentioning

confidence: 99%

Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report

Yealy¹,

Mohr²,

Shapiro³

et al. 2021

Annals of Emergency Medicine

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show abstract

“…Estimation of blood pressure using a non-invasive cuff tends to be inaccurate and the discrepancy more pronounced in shock states [375][376][377][378][379]. Insertion of an arterial catheter permits safe, reliable and continuous measurement of arterial pressure and allows real time analysis so that therapeutic decisions can be based on immediate and accurate blood pressure information [380].…”

Section: Rationalementioning

confidence: 99%

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

et al. 2021

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“…Estimation of blood pressure using a noninvasive cuff tends to be inaccurate and the discrepancy more pronounced in shock states (375)(376)(377)(378)(379). Insertion of an arterial catheter permits safe, reliable and continuous measurement of arterial pressure and allows real time analysis so that therapeutic decisions can be based on immediate and accurate blood pressure information (380).…”

Section: Rationalementioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Evans

Rhodes

Alhazzani

et al. 2021

Critical Care Medicine

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1,081

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shock (27). The specific components of performance improvement did not appear to be as important as the presence of a program that included sepsis screening and metrics.Sepsis screening tools are designed to promote early identification of sepsis and consist of manual methods or automated use of the electronic health record (EHR). There is wide variation in diagnostic accuracy of these tools with most having poor predictive values, although the use of some was associated with improvements in care processes (28)(29)(30)(31). A variety of clinical variables and tools are used for sepsis screening, such as systemic inflammatory response syndrome (SIRS) criteria, vital signs, signs of infection, quick Sequential Organ Failure Score (qSOFA) or Sequential Organ Failure Assessment (SOFA) criteria, National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS) (26,32). Machine learning may improve performance of screening tools, and in a meta-analysis of 42,623 patients from seven studies for predicting hospital acquired sepsis the pooled area under the receiving operating curve (SAUROC) (0.89; 95% CI, 0.86−0.92); sensitivity (81%; 95% CI, 80−81), and specificity (72%; 95% CI, 72−72) was higher for machine learning than the SAUROC for traditional screening tools such as SIRS (0.70), MEWS (0.50), and SOFA (0.78) (32).Screening tools may target patients in various locations, such as in-patient wards, emergency departments, or ICUs (28)(29)(30)32). A pooled analysis of three RCTs did not demonstrate a mortality benefit of active screening (RR, 0.90; 95% CI, 0.51−1.58) (33-35). However, while there is wide variation in sensitivity and specificity of sepsis screening tools, they are an important component of identifying sepsis early for timely intervention.Standard operating procedures are a set of practices that specify a preferred response to specific clinical circumstances (36). Sepsis standard operating procedures, initially specified as Early Goal Directed Therapy have evolved to "usual care" which includes a standard approach with components of the sepsis bundle, early identification, lactate, cultures, antibiotics, and fluids (37). A large study examined the association between implementation of state-mandated sepsis protocols, compliance, and mortality. A retrospective cohort study of 1,012,410 sepsis admissions to 509 hospitals in the United States in a retrospective cohort examined mortality before (27 months) and after (30 months) implementation of New York state sepsis regulations, with a concurrent control population from four other states (38). In this comparative interrupted time series, mortality was lower in hospitals with higher compliance with achieving the sepsis bundles successfully.Lower resource countries may experience a different effect. A meta-analysis of two RCTs in Sub-Saharan Africa found higher mortality (RR, 1.26; 95% CI, 1.00−1.58) with standard operating procedures compared with usual care, while it was decreased in one observational study (adjusted hazard ratio [HR]; 95% CI, 0.55...

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Comparison of noninvasive blood pressure monitoring with invasive arterial pressure monitoring in medical ICU patients with septic shock

Abstract: In our patients admitted to the medical ICU with septic shock, noninvasive blood pressure monitoring did not clinically correlate with invasive blood pressure measurements.

Cited by 30 publications

References 15 publications

Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report

Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

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