Hi all
Was sent the following. I have some thoughts about it but was wondering
what the folks here think of it.
Thanks for any input.
Regards all
Jel Coward
Hypotension Begins at 110 mm Hg: Redefining "Hypotension" With Data.
Original Articles
Journal of Trauma-Injury Infection & Critical Care. 63(2):291-299, August 2007.
Eastridge, Brian J. MD; Salinas, Jose PhD; McManus, John G. MD; Blackburn,
Lorne MD; Bugler, Eileen M. MD; Cooke, William H. PhD; Concertino, Victor
A. PhD; Wade, Charles E. PhD; Holcomb, John B. MD
Abstract:
Background: Clinicians routinely refer to hypotension as a systolic blood
pressure (SBP) <=90 mm Hg. However, few data exist to support the rigid
adherence to this arbitrary cutoff. We hypothesized that the physiologic
hypoperfusion and mortality outcomes classically associated with
hypotension were manifest at higher SBPs.
Methods: A total of 870,634 patient records from the National Trauma Data
Bank with emergency department SBP and mortality data were analyzed.
Patients (140,898) with severe head injuries, a Glasgow Coma Score <=8, and
base deficit (BD) <5, or missing data items were excluded from analysis.
Admission BD, as a measure of metabolic hypoperfusion, was evaluated in
81,134 patients and mortality was plotted against SBP.
Results: Baseline mortality was <2.5%. However, at 110 mm Hg, the slope of
the mortality curve increased such that mortality was 4.8% greater for
every 10-mm Hg decrement in SBP. This effect was consistent to a maximum of
26% mortality at a SBP of 60 mm Hg. Hypoperfusion (change in the slope of
BD curve) began to increase above baseline of 4.5 at a SBP 118 mm Hg.
Conclusion: Taking the BD and mortality measurements together, this
analysis shows that a SBP <=110 mm Hg is a more clinically relevant
definition of hypotension and hypoperfusion than is 90 mm Hg. This analysis
will also be useful for developing appropriately powered studies of
hemorrhagic shock.
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