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Published on: March 26, 2019
Invasive Arterial Blood Pressure Monitoring to Detect Postintubation Hypotension in Patients Who Receive a
Silas Houghton Budd1, Nick Haslam2, Joanne Griggs3
1Air Ambulance Charity Kent Surrey Sussex, Redhill, United Kingdom; South East Coast Ambulance Service, Crawley, United Kingdom.
Objective:
The prehospital management of moderate/severe traumatic brain injury (TBI) centers on preventing secondary brain injury. Prehospital emergency anesthesia (PHEA) may be required for optimal neuroprotective care. Continuous invasive arterial blood pressure (IBP) monitoring is increasingly used in this cohort. PHEA can result in significant blood pressure (BP) changes, particularly around induction. IBP allows targeted BP management. This study analyzed hypotension frequency, depth, and duration in patients with suspected TBI monitored with IBP before PHEA.
Methods:
This was a retrospective analysis of patients with suspected TBI attended by Air Ambulance Charity Kent Surrey Sussex (KSS) who received IBP before PHEA between January 6, 2022, and July 6, 2024. The magnitude and duration of "absolute hypotension" (systolic BP [SBP], < 90 mm Hg) were combined to establish a dose of absolute hypotension (mm Hg × minutes). The primary endpoints were incidence and dose of absolute hypotension.
Results:
A total of 305 patients were identified; 140 (45.9%) were included. The median age was 58 years (interquartile range [IQR], 42-73), the predominant sex was male (n = 108; 77%), and the median Glasgow coma scale score was 6/15 (IQR, 4.0-7.5). Thirteen patients (9.3%) had absolute hypotension before PHEA, increasing to 53 (37.9%) after PHEA. Twenty-five patients (47.2%) had initial absolute hypotensive episodes that occurred 5 minutes after PHEA, with a median duration of 3 minutes (IQR, 1.0-4.5). The median dose of absolute hypotension was 144 mm Hg × minutes (IQR, 3.75-1,675.5). Twenty-five patients (17.9%) had "clinically important hypotension" (SBP, < 110 mm Hg) before PHEA, increasing to 80 after PHEA (57.1%). Pre-PHEA absolute and clinically important hypotension were associated with both incidence and dose of post-PHEA absolute hypotension.
Conclusion:
This study highlights a higher incidence of absolute hypotension using IBP than previous studies using intermittent noninvasive monitoring. Although post-PHEA absolute hypotension was common, more than half of these events were brief (< 5 minutes). These findings highlight the importance of analyzing hypotension depth and duration and suggest the need for prehospital outcome-based studies using continuous IBP.
