Most patients with non-hypertensive diseases at a critical care resuscitation unit require arterial pressure monitoring: a prospective observational study

BACKGROUND:Blood pressure(BP)monitoring is essential for patient care.Invasive arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is unknown.We hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of resuscitation.METHODS:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,2021.Management plans to maintain a mean arterial pressure>65 mmHg(1 mmHg=0.133 kPa)were recorded in real time for both NIBP and IABP measurements.A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion.Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)values.RESULTS:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])patients.The most common COM was an increase in current infusion dosages(40 patients,19.4%).Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without(45[47.9%]vs.32[28.6%],P=0.004).Receiving norepinephrine(relative variable importance[RVI]100%)was the most signifi cant factor associated with a COM.No complications were identifi ed with IABP use.CONCLUSION:A COM occurred in 94(45.6%)non-hypertensive patients in the CCRU.Receiving vasopressors was the greatest factor associated with COM.Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase.Further studies are necessary to confi rm the risk-to-benefi t ratios of IABP among these high-risk patients.

Effects of acupuncture on the relationship between cerebral hemodynamics and arterial blood pressure in patients with hypertension

The present study aimed to investigate the effect of an auricular acupuncture intervention on the relationship between changes in oxyhemoglobin concentration(Δ[O2Hb])and arterial blood pressure(ABP).The cerebral oxygenation signals in the bilateral prefrontal cortex(PFC),sensorimotor cortex(SMC),and temporal lobe cortex(TLC)of 15 patients with hypertension were measured by a 24-channel functional near-infrared spectroscopy(fNIRS)device before(State_R)and after(State_AT)the auricular acupuncture intervention.Coupling strength was used to quantitatively evaluate the strength of the couplings between ABP andΔ[O2Hb]in low-frequency oscillations(LF,0.07–0.2 Hz)and very-low-frequency oscillations(VLF,0.02–0.07 Hz).Results showed that the changes in wavelet amplitudes in the LF and VLF intervals did not exhibit significant differences after auricular acupuncture.The coupling strength from ABP toΔ[O2Hb]was significantly lower in the LF range after auricular acupuncture in the bilateral PFC,SMC,and TLC(p<0.0083).Additionally,the coupling strength from ABP toΔ[O2Hb]in the VLF range was significantly lower in the bilateral PFC in State_AT than in State_R(p<0.0083).These results indicated that fNIRS together with ABP can effectively evaluate cerebral hemodynamic responses to interventions and is therefore capable of guiding more individualized acupuncture strategies.The auricular acupuncture intervention improved hemodynamic responses in patients suffering from hypertension.

Effect of Electroacupuncturing Heart Meridian on Arterial Blood Pressure with Myocardial Ischemia in Rabbits

Objective: To explore the relationship between Heart Meridian (HM) and cardiac function.Methods: Forty-eight rabbits with acute myocardial ischemia resulting from intravenous pituitrin injection was established. Electroacupuncture (EA) on the HM and the Lung Meridian, 3 points for each, was applied and their change of arterial pressure was observed.Results: Distinct difference existed in the improvement of arterial pressure on the HM and Lung Meridian with EA. The regulatory action of EA in HM on the cardiac function was significantly better than that of EA in Lung Meridian.Conclusion: HM was closely related to the cardiac function.

Preliminary study of abnormal increase of postexercise systolic blood pressure in the diagnosis of coronary artery disease

Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST - segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST - segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.

A Novel Technique to Maintain Radial Arterial Catheter Position: The Arterial Catheter Stabilizer

Despite widespread use of arterial catheters, there is remarkably little described about their stabilization in the literature. A brief review of arterial catheterization techniques is included. The fixation techniques described in the literature and in commercial product information are essentially to tape or suture the arterial catheter flat against the skin. Often the wrist is immobilized in the dorsiflexed position to prevent kinking or dislodging of the catheter. We describe a simple device made from a gauze pad and tape to elevate and protect the arterial line while minimizing its kinking during wrist flexion.

Effects of renal artery stenting on renal function and blood pressure in patients with atherosclerotic renovascular disease

Objective To study the effects of percutaneous renal artery intervention on renal function and blood pressure in patients with renal artery stenosis. Methods Eighty-seven patients with severe uni- or bi-lateral renal artery stenosis (luminal diameter narrowing ≥70%) and clinical hypertension received renal artery stenting between January 2002 and December 2002. The changes in blood pressure and serum creatinine level and creatinine clearance (CCr) 48 hours after intervention and during 6 months of follow-up were assessed.Results Renal stenting was performed in 98 stenotic arteries of 87 patients,and the procedural success rate was 100%. Serum creatinine level was slightly elevated from (176±21) μmol/L to (179±11) μmol/L ( P =0.15) 48 hours after the procedure,but significantly decreased to (149±15) μmol/L at 6 months ( P <0.001). CCr was also greatly improved [(37±11) ml/min before versus (51±8) ml/min at 6 months,P <0.001]. During follow-up,61% of the patients experienced a normal renal function. Despite conventional medical treatment,systolic and diastolic blood pressures were also significantly decreased after stenting [(163±23)/(96±13) mm Hg before versus (148±12)/(79±15) mm Hg at 6 months,all P <0.001],and hypertension was well controlled in 67% of the patients at 6 months’ follow-up.Conclusion Renal artery stenting has a high success rate and is effective in improving renal function and blood pressure for patients with severe renal artery stenosis.

Effects of antihypertensives on arterial responses associated with obstructive sleep apneas

Background Many patients with obstructive sleep apnea syndrome (OSAS) have complicated with hypertension and may be prescribed with antihypertension medications to control their blood pressure But whether antihypertension medications can also decrease arterial stiffness or control the blood pressure increasing following obstructive events is not well described This study aimed to investigate whether antihypertensive medications can ameliorate the changes in arterial stiffness and blood pressure associated with OSA Methods Sixtyone OSAS patients [13 women, 48 men, mean age (534±123) years], 26 normotensive patients (N), 7 hypertensive patients on no antihypertension medications (H), and 28 hypertensive patients on various combination antihypertension therapy (HM), were prospectively diagnosed with standard nocturnal polysomnography Beattobeat blood pressure was continuously recorded from the radial artery by applanation tonometry during baseline sleep As a measure of arterial stiffness, arterial augmentation index (AAI) was calculated as the ratio of augmented systolic blood pressure (SBP) to pulse pressure and expressed as a percentage for the following conditions: awakening, the first 10 ('early apnea') and last 10 ('late apnea') cardiac cycles of obstructive events (apnea or hypopnea), and the first 15 cardiac cycles following event termination ('post apnea') for all events with nadir O2 saturation ≤89% Results Systolic blood pressure (SBP) postapnea [(14274±1306) mmHg (N), (13706±2656) mmHg (H), (13694±141) mmHg (HM)] was significantly increased from awakening [(13576±1476) mmHg (N), (13558±2317) mmHg (H), (12977±1400) mmHg (HM)], early apnea [(13053±1265) mmHg (N), (12447±2497) mmHg (H), (12604±1312) mmHg (HM)], and late apnea [(1298±1268) mmHg(N), (12478±2515) mmHg (H), (12448±1382) mmHg (HM)] respectively (P<0001, repeated measures ANOVA) AAI was significantly increased for the N group (P<0001) from awakening to late apnea [(1045±262)% vs (1443±321)%] and from early apnea to late apnea [(1061±234)% vs (1443±321)%], and also for H group (P<005) from awakening to late apnea [(1123±387)% vs (1632±802)%] and from early apnea to late apnea [(1175±379)% vs (1632±802)%] Meanwhile, no significant differences in AAI among awakening, early apnea, late apnea, and postapnea conditions were found in HM group Conclusions The current data demonstrate that systemic blood pressure increases significantly during the postapneic phase of OSAS, compared with that during awakening and intraapnea phases even with the use of combined antihypertensive therapy which could normalize BP during awakening in the hypertensive patients However, increases in arterial stiffness during obstructive events could be ameliorated by combined antihypertension medications