Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review

Meng, Lingzhong

doi:10.1016/j.bja.2021.06.048

Cited by 66 publications

(39 citation statements)

References 169 publications

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“…Although the vital organs of the body have a certain selfregulation ability (28,29), which allows important organs such as the heart, brain, kidney, and other important organs to maintain perfusion through their own regulation when the blood pressure decreases, this ability is lost when the blood pressure is lower than a certain level. Moreover, if the blood pressure continues to fail to recover, severe organ failure and death are inevitable, and higher blood pressures also present the risk of re-injury caused by hyperperfusion.…”

Section: Discussionmentioning

confidence: 99%

Non-linear relationship between baseline mean arterial pressure and 30-day mortality in patients with sepsis: a retrospective cohort study based on the MIMIC-III database

Cao¹,

Chen²,

Tang³

et al. 2022

Ann Transl Med

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Background: Sepsis is a life-threatening organ dysfunction due to disturbance of the host's response to infection, and is often accompanied by shock. Timely and standardized hemodynamic management can effectively control disease progression. Mean arterial pressure (MAP) refers to tissue and organ perfusion and is one of the key factors for patient recovery. In this study, we focused on the relationship between MAP levels and 30-day mortality in patients with sepsis.Methods: This cohort study included 14,607 sepsis patients out of 38,597 adults admitted to Beth Israel Deaconess Medical Center in Boston between 2001 and 2012, according to the Sepsis 3.0 diagnostic criteria. According to the MAP value of the sepsis patients on the first day of intensive care unit (ICU) admission, they were divided into 5 groups (Q1 ≤67.4 mmHg, Q2 67.4-72.5 mmHg, Q3 72.5-77.6 mmHg, Q4 77.6-84.6 mmHg, Q5 ≥84.6 mmHg). At the same time, the baseline data of vital signs, critical illness score, comorbidities and laboratory examination were collected on the first day of admission to ICU. The 30-day mortality of the 5 groups of patients and the overall sepsis patients were recorded. Multivariate Cox regression analysis and smooth curve fitting were used to assess the independent association between MAP and 30-day mortality.Results: A total of 14,607 sepsis patients were screened. The mean age of participants was 67.2±16.3 years, approximately 46.9% were women, and the overall 30-day mortality rate was 21.0%. Multivariate Cox regression models and smooth curve fitting revealed a non-linear association between MAP and 30-day mortality. The inflection point occurred at 68.6 mmHg. The left side effect size of each 10-unit change in the exposure factor was [hazard ratio (HR): 0.479, 95% confidence interval (CI): 0.403-0.569, P<0.001]. To the right of the inflection point, the effect size was (HR: 0.996, 95% CI: 0.931-1.065, P<0.9018).Conclusions: Our study demonstrated a non-linear relationship between MAP and 30-day mortality in patients with sepsis. When MAP was less than 68.6 mmHg, it was a strong predictor of the potential risk of sepsis death, which is declined by 52.1% for every 10 mmHg growth in MAP.

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Section: Discussionmentioning

confidence: 99%

Non-linear relationship between baseline mean arterial pressure and 30-day mortality in patients with sepsis: a retrospective cohort study based on the MIMIC-III database

Cao¹,

Chen²,

Tang³

et al. 2022

Ann Transl Med

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show abstract

“…The thickening of the medial wall of cerebral small vessels, coupled with proliferating intima, increased cerebral vascular resistance in patients with CSVD (Birns et al, 2005 ). Organ perfusion decreases if perfusion pressure decreases with an increased vascular resistance (Meng, 2021 ). Previous study found that cerebral perfusion was reduced in areas of WMH compared with areas with normal white matter (Marstrand et al, 2002 ).…”

Section: Discussionmentioning

confidence: 99%

Sex disparity of cerebral white matter hyperintensity in the hypertensive elderly: The Shanghai Changfeng study

Wang

Lin

Zhao

et al. 2022

Human Brain Mapping

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White matter hyperintensity (WMH) is associated with vascular hemodynamic alterations and reflects white matter injury. To date, the sex difference of tract‐specific WMH and the relationship between high blood pressure (BP) and tract‐specific WMH remain unclear. We recruited 515 subjects from the Shanghai Changfeng study (range 53–89 years, mean age 67.33 years). Systolic and diastolic blood pressure (SBP and DBP) were collected and used to calculate pulse pressure (PP). Magnetic resonance T1 and T2 FLAIR images were acquired to measure WMH and calculate WMH index. The ANCOVA test was performed to test the difference between sexes, and the linear regression model was used to examine the associations between BP and WMH index. Men showed higher WMH index than women in all white matter tracts (p < .001, respectively) except for the bilateral superior longitudinal fasciculus (SLF) and its left temporal part (tSLF). High SBP and PP was associated with a lower WMH index on the left corticospinal tract (CST), SLF, tSLF and right cingulum in hippocampus (p ≤ .001, respectively) in women, while high DBP was associated with a higher WMH index on the bilateral CST (left p < .001; right p = .001), left inferior longitudinal fasciculus (p < .001) and inferior fronto‐occipital fasciculus (p = .002) in men. Men tend to have more WMH compared to women. A high SBP/PP relates to a lower WMH burden in women. This suggests that women could benefit from higher blood pressure in older age.

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“…In fact, this oversimplification does not consider the auto-regulatory mechanisms, one for each organ, which make the blood flow vary according to the tissue demand, and that we cannot "measure" bedside, so far [4,5]. Furthermore, these mechanisms are differently affected by anesthesia or diseases.…”

Section: One Monitoring Device Does Not Fit Allmentioning

confidence: 99%

Comment on "Noninvasive cardiac output measurements are inaccurate in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation"

Giustiniano

Nisi

Piccioni

2023

Korean J Anesthesiol

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Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review

Cited by 66 publications

References 169 publications

Non-linear relationship between baseline mean arterial pressure and 30-day mortality in patients with sepsis: a retrospective cohort study based on the MIMIC-III database

Non-linear relationship between baseline mean arterial pressure and 30-day mortality in patients with sepsis: a retrospective cohort study based on the MIMIC-III database

Sex disparity of cerebral white matter hyperintensity in the hypertensive elderly: The Shanghai Changfeng study

Comment on "Noninvasive cardiac output measurements are inaccurate in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation"

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Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review

Cited by 66 publications

References 169 publications

Non-linear relationship between baseline mean arterial pressure and 30-day mortality in patients with sepsis: a retrospective cohort study based on the MIMIC-III database

Non-linear relationship between baseline mean arterial pressure and 30-day mortality in patients with sepsis: a retrospective cohort study based on the MIMIC-III database

Sex disparity of cerebral white matter hyperintensity in the hypertensive elderly: The Shanghai Changfeng study

Comment on &quot;Noninvasive cardiac output measurements are inaccurate in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation&quot;

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Comment on "Noninvasive cardiac output measurements are inaccurate in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation"