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Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering

BACKGROUND: Blood pressure is a critical therapeutic goal in intensive care unit (ICU). One important factor influencing blood pressure are analgesia and sedation. Analgesic and sedative drugs are commonly used in critically ill patients. These drugs affect blood pressure by reducing the tension of...

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Autores principales: Liu, Shengjun, Su, Longxiang, Liu, Xin, Zhang, Xueqian, Chen, Zuyu, Liu, Chun, Hong, Na, Li, Yali, Long, Yun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8506777/
https://www.ncbi.nlm.nih.gov/pubmed/34733956
http://dx.doi.org/10.21037/atm-21-2806
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author Liu, Shengjun
Su, Longxiang
Liu, Xin
Zhang, Xueqian
Chen, Zuyu
Liu, Chun
Hong, Na
Li, Yali
Long, Yun
author_facet Liu, Shengjun
Su, Longxiang
Liu, Xin
Zhang, Xueqian
Chen, Zuyu
Liu, Chun
Hong, Na
Li, Yali
Long, Yun
author_sort Liu, Shengjun
collection PubMed
description BACKGROUND: Blood pressure is a critical therapeutic goal in intensive care unit (ICU). One important factor influencing blood pressure are analgesia and sedation. Analgesic and sedative drugs are commonly used in critically ill patients. These drugs affect blood pressure by reducing the tension of the venous system, the cardiac preload, and cardiac output and inhibiting cardiac functions. Consequently, vasoactive agents are commonly used to increase blood pressure. The indications for the usage of vasoactive agents are unequivocal. However, opinions on when to stop raising blood pressure vary. This study explored the relationship between blood pressure and sedation. METHODS: Patients in the Multiparameter Intelligent Monitoring in Intensive Care-III (MIMIC) database who had received mechanical ventilation, had been administered sedative analgesics during their ICU stay, and met the inclusion criteria were included in this study. The mean arterial pressure (MAP) tendency patterns were identified using spectral clustering and visualized using the t-distributed Stochastic Neighbor Embedding (t-SNE) algorithm. The 28-day mortality rates of patients with different MAP patterns during their first 24 hours in the ICU and their sedation levels were calculated in the crosstab. RESULTS: Fourteen thousand seven hundred and eighty-five patients from the MIMIC-III database were included in this study. Three MAP patterns were identified by spectral clustering. The median MAP of the low, moderate, and high MAP groups was 71.2, 80.4, and 97.6 mmHg, respectively. The 28-day mortality rate of patients in the moderate MAP group (13.0%) was lower than that of patients in the low (16.6%) and high (15.6%) MAP groups. No difference was found in the 28-day mortality rate between the low and high MAP groups. Dynamic changes in blood pressure at different sedation depths were also examined. Notably, compared with light and moderate sedation level, patients in the deep sedation group, especially those in the high MAP group (48.5%), had a higher 28-day mortality rate (36.5%). CONCLUSIONS: Low MAP in the first 24 hours in ICU indicates a high possibility of poor prognosis for critically ill patients on mechanical ventilation. For patients under deep sedation, maintaining a high mean arterial pressure also indicates poor prognosis. A personalized MAP target should be determined according to the severity of illness and level of sedation for each patient.
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spelling pubmed-85067772021-11-02 Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering Liu, Shengjun Su, Longxiang Liu, Xin Zhang, Xueqian Chen, Zuyu Liu, Chun Hong, Na Li, Yali Long, Yun Ann Transl Med Original Article BACKGROUND: Blood pressure is a critical therapeutic goal in intensive care unit (ICU). One important factor influencing blood pressure are analgesia and sedation. Analgesic and sedative drugs are commonly used in critically ill patients. These drugs affect blood pressure by reducing the tension of the venous system, the cardiac preload, and cardiac output and inhibiting cardiac functions. Consequently, vasoactive agents are commonly used to increase blood pressure. The indications for the usage of vasoactive agents are unequivocal. However, opinions on when to stop raising blood pressure vary. This study explored the relationship between blood pressure and sedation. METHODS: Patients in the Multiparameter Intelligent Monitoring in Intensive Care-III (MIMIC) database who had received mechanical ventilation, had been administered sedative analgesics during their ICU stay, and met the inclusion criteria were included in this study. The mean arterial pressure (MAP) tendency patterns were identified using spectral clustering and visualized using the t-distributed Stochastic Neighbor Embedding (t-SNE) algorithm. The 28-day mortality rates of patients with different MAP patterns during their first 24 hours in the ICU and their sedation levels were calculated in the crosstab. RESULTS: Fourteen thousand seven hundred and eighty-five patients from the MIMIC-III database were included in this study. Three MAP patterns were identified by spectral clustering. The median MAP of the low, moderate, and high MAP groups was 71.2, 80.4, and 97.6 mmHg, respectively. The 28-day mortality rate of patients in the moderate MAP group (13.0%) was lower than that of patients in the low (16.6%) and high (15.6%) MAP groups. No difference was found in the 28-day mortality rate between the low and high MAP groups. Dynamic changes in blood pressure at different sedation depths were also examined. Notably, compared with light and moderate sedation level, patients in the deep sedation group, especially those in the high MAP group (48.5%), had a higher 28-day mortality rate (36.5%). CONCLUSIONS: Low MAP in the first 24 hours in ICU indicates a high possibility of poor prognosis for critically ill patients on mechanical ventilation. For patients under deep sedation, maintaining a high mean arterial pressure also indicates poor prognosis. A personalized MAP target should be determined according to the severity of illness and level of sedation for each patient. AME Publishing Company 2021-09 /pmc/articles/PMC8506777/ /pubmed/34733956 http://dx.doi.org/10.21037/atm-21-2806 Text en 2021 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Liu, Shengjun
Su, Longxiang
Liu, Xin
Zhang, Xueqian
Chen, Zuyu
Liu, Chun
Hong, Na
Li, Yali
Long, Yun
Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering
title Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering
title_full Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering
title_fullStr Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering
title_full_unstemmed Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering
title_short Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering
title_sort recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8506777/
https://www.ncbi.nlm.nih.gov/pubmed/34733956
http://dx.doi.org/10.21037/atm-21-2806
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