Results of a survey of blood pressure monitoring by intensivists in critically ill patients: A preliminary study

BACKGROUND: Although we have insufficient knowledge about the effects of Trendelenburg positions on various hemodynamic parameters, these positions are frequently used to influence cardiac output and blood pressure in critically ill patients. OBJECTIVES: To determine the effect of Trendelenburg and modified Trendelenburg positions on five dependent variables: cardiac output, cardiac index, mean arterial pressure, systemic vascular resistance, and oxygenation in critically ill patients. METHODS: In this preliminary study subjects were 23 cardiac surgery patients (mean age, 55; SD, 8.09) who had a pulmonary artery catheter for cardiac output determination and who were clinically stable, normovolemic and normotensive. Baseline measurements of the dependent variables were taken in the supine position. Patients were then placed in 10 degrees Trendelenburg or 30 degrees modified Trendelenburg position. The dependent variables were measured after 10 minutes in each position. A 2-period, 2-treatment crossover design with a preliminary baseline measurement was used. RESULTS: Five subjects were unable to tolerate Trendelenburg position because of nausea or pain in the sternal incision. In the 18 who were able to tolerate both position changes, no statistically significant changes were found in the five dependent variables. Changes in systemic vascular resistance over time approached statistical significance and warrant further study. CONCLUSIONS: This preliminary study does not provide support for Trendelenburg positions as a means to influence hemodynamic parameters such as cardiac output and blood pressure in normovolemic and normotensive patients.

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Diagnosis of Hypertension in a Family Practice Setting: A Preliminary Study of Published Protocol Versus 24-Hour Ambulatory Blood Pressure Monitoring

Southern Medical Journal ◽

10.1097/00007611-198812000-00009 ◽

1988 ◽

Vol 81 (12) ◽

pp. 1499-1504

Author(s):

JACQUES PYE ◽

JAMES L. FLETCHER ◽

PAUL M. FISCHER ◽

FRANCES E. MILLER ◽

L MICHAEL PRISANT ◽

...

Keyword(s):

Blood Pressure ◽

Family Practice ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Practice Setting ◽

Pressure Monitoring ◽

Preliminary Study ◽

Diagnosis Of Hypertension

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Suitability, Efficacy, and Safety of Vernakalant for New Onset Atrial Fibrillation in Critically Ill Patients

Critical Care Research and Practice ◽

10.1155/2014/826286 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Alain Rudiger ◽

Alexander Breitenstein ◽

Mattia Arrigo ◽

Sacha P. Salzberg ◽

Dominique Bettex

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Sinus Rhythm ◽

Critically Ill ◽

Critically Ill Patients ◽

Blood Pressure Monitoring ◽

Exclusion Criteria ◽

Arterial Blood ◽

Onset Atrial Fibrillation ◽

New Onset

Objectives. This study investigates the suitability, safety, and efficacy of vernakalant in critically ill patients with new onset atrial fibrillation (AF) after cardiac surgery.Methods. Patients were screened for inclusion and exclusion criteria according to the manufacturers’ recommendations. Included patients were treated with 3 mg/kg of vernakalant over 10 min and, if unsuccessful, a second dose of 2 mg/kg. Blood pressure was measured continuously for 2 hours after treatment.Results. Of the 191 patients screened, 159 (83%) were excluded, most importantly due to hemodynamic instability (59%). Vernakalant was administered to 32 (17% of the screened) patients. Within 6 hours, 17 (53%) patients converted to sinus rhythm. Blood pressure did not decrease significantly 10, 30, 60, and 120 minutes after the vernakalant infusion. However, 11 patients (34%) experienced a transient decrease in mean arterial blood pressure <60 mmHg. Other adverse events included nausea (n=1) and bradycardia (n=2).Conclusions. Applying the strict inclusion and exclusion criteria provided by the manufacturer, only a minority of postoperative ICU patients with new onset AF qualified for vernakalant. Half of the treated patients converted to sinus rhythm. The drug was well tolerated, but close heart rate and blood pressure monitoring remains recommended.

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