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Hypotension During Vasopressor Infusion Occurs in Predictable Clusters: A Multicenter Analysis.

Daisuke Horiguchi1,2, Sungtae Shin3, Jeremy A Pepino1

  • 1Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.

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Summary
This summary is machine-generated.

Most hypotension in ICUs occurs in predictable clusters. Analyzing mean arterial pressure (MAP) trends can help clinicians anticipate and manage these hypotension events, improving patient outcomes.

Keywords:
forecastinghealth carehypotensionquality assuranceshockvasoconstrictor agents

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Area of Science:

  • Critical Care Medicine
  • Cardiovascular Physiology
  • Health Informatics

Background:

  • Hypotension (low mean arterial pressure) is linked to adverse outcomes in ICUs.
  • Effective management of mean arterial pressure (MAP) remains challenging.
  • Understanding hypotension patterns is crucial for improving patient care.

Purpose of the Study:

  • To characterize the occurrences of hypotension in intensive care units (ICUs).
  • To assess the predictability of hypotension using mean arterial pressure (MAP) trends.
  • To inform strategies for better MAP management in critically ill patients.

Main Methods:

  • Retrospective analysis of adult ICU patients receiving vasopressors across three hospitals.
  • Defined "hypotension-clusters" (cumulative hypotension over 60 min) and "constant hypotension" (continuous).
  • Utilized MAP trend analysis to predict future hypotension based on preceding data.

Main Results:

  • The majority of hypotension events occurred within defined "hypotension-clusters".
  • MAP trend analysis successfully predicted most "hypotension-clusters" before constant hypotension ensued (81.2%-93.6% sensitivity).
  • Positive predictive values for hypotension prediction ranged from 51.4% to 72.9%.

Conclusions:

  • Hypotension in ICUs frequently manifests in temporal clusters.
  • These hypotension clusters are often predictable by extrapolating mean arterial pressure trends.
  • Predictive analysis of MAP trends offers potential for proactive hypotension management.