Adjusting mean arterial pressure alarms improves the time spent within blood pressure targets in patients with septic shock: A quasi-experimental study.
Mean arterial pressure
Monitoring
Norepinephrine
Septic shock
Journal
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
ISSN: 1036-7314
Titre abrégé: Aust Crit Care
Pays: Australia
ID NLM: 9207852
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
12
05
2020
revised:
20
07
2020
accepted:
10
10
2020
pubmed:
29
11
2020
medline:
25
11
2021
entrez:
28
11
2020
Statut:
ppublish
Résumé
Norepinephrine is the first-line vasoactive drug in septic shock. As underdosages or overdosages can be harmful for patients, it seems useful to maintain the mean arterial pressure (MAP) within preset bounds. We sought to assess whether adjusted MAP alarms could improve MAP control in patients with septic shock. We conducted a quasi-experimental before-and-after study. During two consecutive periods, data on MAP control were obtained from patients with septic shock (n = 50/period) treated with norepinephrine over more than 24 h. The norepinephrine administration protocol, including prescription of the MAP target range (e.g., 65-75 mmHg), was identical during the two periods. During the first period (control group), the preset alarms of the monitor were used (i.e., low and high systolic blood pressure alarms set at 90 and 160 mmHg, respectively). During the second period, adjusted MAP alarms were implemented, with upper and lower bounds corresponding to the prescribed MAP target range (MAP-Alarm group). The primary end point was the percentage of time outside the desired MAP target range during the first 24 h of norepinephrine infusion. Baseline characteristics were not significantly different. The primary end point was significantly lower in the MAP-Alarm group than in the control group (25 ± 13% versus 51 ± 18%, respectively; p < 0.01). MAP was higher than the target 14 ± 11% of the time in the MAP-Alarm group versus 37 ± 17% in the control group (p < 0.01) and lower than the target 11 ± 9% of the time in the MAP-Alarm versus 21 ± 22% in the control group (p < 0.05). There was no significant difference between the two groups with regard to the dose of norepinephrine, duration of norepinephrine administration, and survival. These results suggest that adjusting MAP alarms to the desired MAP target range could dramatically improve the percentage of time spent within MAP targets in patients with septic shock but does not reduce exposure to norepinephrine.
Sections du résumé
BACKGROUND
BACKGROUND
Norepinephrine is the first-line vasoactive drug in septic shock. As underdosages or overdosages can be harmful for patients, it seems useful to maintain the mean arterial pressure (MAP) within preset bounds.
OBJECTIVES
OBJECTIVE
We sought to assess whether adjusted MAP alarms could improve MAP control in patients with septic shock.
METHODS
METHODS
We conducted a quasi-experimental before-and-after study. During two consecutive periods, data on MAP control were obtained from patients with septic shock (n = 50/period) treated with norepinephrine over more than 24 h. The norepinephrine administration protocol, including prescription of the MAP target range (e.g., 65-75 mmHg), was identical during the two periods. During the first period (control group), the preset alarms of the monitor were used (i.e., low and high systolic blood pressure alarms set at 90 and 160 mmHg, respectively). During the second period, adjusted MAP alarms were implemented, with upper and lower bounds corresponding to the prescribed MAP target range (MAP-Alarm group). The primary end point was the percentage of time outside the desired MAP target range during the first 24 h of norepinephrine infusion.
RESULTS
RESULTS
Baseline characteristics were not significantly different. The primary end point was significantly lower in the MAP-Alarm group than in the control group (25 ± 13% versus 51 ± 18%, respectively; p < 0.01). MAP was higher than the target 14 ± 11% of the time in the MAP-Alarm group versus 37 ± 17% in the control group (p < 0.01) and lower than the target 11 ± 9% of the time in the MAP-Alarm versus 21 ± 22% in the control group (p < 0.05). There was no significant difference between the two groups with regard to the dose of norepinephrine, duration of norepinephrine administration, and survival.
CONCLUSIONS
CONCLUSIONS
These results suggest that adjusting MAP alarms to the desired MAP target range could dramatically improve the percentage of time spent within MAP targets in patients with septic shock but does not reduce exposure to norepinephrine.
Identifiants
pubmed: 33246865
pii: S1036-7314(20)30309-X
doi: 10.1016/j.aucc.2020.10.002
pii:
doi:
Substances chimiques
Norepinephrine
X4W3ENH1CV
Types de publication
Journal Article
Langues
eng
Pagination
358-362Informations de copyright
Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest None of the authors have any conflict of interest to declare.