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Recalling that I am a "flea" so perhaps don't have the correct
outlook, I find this study hard to buy into. Consider that
Lewington, et al showed in hypertension studies, using 7,000,000 patient
years of data, that the lowest risk of CV mortality was with a BP of
115/75 (and mortality doubles for every 20/10 increase). <br><br>
So ideal (lowest risk, anyway) SBP=115, and
hypotension/hypoperfusion=110????????<br>
I have always been taught that hypoperfusion was a clinical finding, and
the SBP of the patient was NEVER an absolute indicator of
perfusion. Even with a medical patients on pressors, with an
arterial line with a good wave form, where I might write an order to keep
MAP>=60, that was only after looking at the patient, knowing that a
MAP of 60 did provide perfusion, and knowing their volume status - always
with nurses I knew would do the same assessments in my absence (no matter
what I wrote for that matter, for which I was VERY thankful :) ).
<br><br>
I don't doubt the data showed what they report, but does it really have
any clinical usefulness?<br><br>
Lorick<br><br>
<br>
At 05:18 PM 8/17/2007, you wrote:<br>
<blockquote type=cite class=cite cite="">
<a href="http://www.jtrauma.com/pt/re/jtrauma/abstract.00005373-200708000-00007.htm;jsessionid=GFtCWRqSTgyYvxM1LBmyN1HGGhQg52n2Zm3LnB5WJk2c8yZLQn6q!1152499061!181195629!8091!-1" eudora="autourl">
http://www.jtrauma.com/pt/re/jtrauma/abstract.00005373-200708000-00007.htm;jsessionid=GFtCWRqSTgyYvxM1LBmyN1HGGhQg52n2Zm3LnB5WJk2c8yZLQn6q!1152499061!181195629!8091!-1</a>
<br><br>
*Hypotension Begins at 110 mm Hg: Redefining
"Hypotension" With Data.*<br><br>
*Original Articles*<br>
Journal of Trauma-Injury Infection & Critical Care. 63(2):291-299,
August<br>
2007.<br>
*Eastridge, Brian J. MD; Salinas, Jose PhD; McManus, John G. MD;
Blackburn,<br>
Lorne MD; Bugler, Eileen M. MD; Cooke, William H. PhD; Concertino, Victor
A.<br>
PhD; Wade, Charles E. PhD; Holcomb, John B. MD *<br><br>
*Abstract:*<br>
Background: Clinicians routinely refer to hypotension as a systolic
blood<br>
pressure (SBP) <=90 mm Hg. However, few data exist to support the
rigid<br>
adherence to this arbitrary cutoff. We hypothesized that the
physiologic<br>
hypoperfusion and mortality outcomes classically associated with
hypotension<br>
were manifest at higher SBPs.<br><br>
Methods: A total of 870,634 patient records from the National Trauma
Data<br>
Bank with emergency department SBP and mortality data were analyzed.<br>
Patients (140,898) with severe head injuries, a Glasgow Coma Score
<=8, and<br>
base deficit (BD) <5, or missing data items were excluded from
analysis.<br>
Admission BD, as a measure of metabolic hypoperfusion, was evaluated
in<br>
81,134 patients and mortality was plotted against SBP.<br><br>
Results: Baseline mortality was <2.5%. However, at 110 mm Hg, the
slope of<br>
the mortality curve increased such that mortality was 4.8% greater for
every<br>
10-mm Hg decrement in SBP. This effect was consistent to a maximum of
26%<br>
mortality at a SBP of 60 mm Hg. Hypoperfusion (change in the slope of
BD<br>
curve) began to increase above baseline of 4.5 at a SBP 118 mm
Hg.<br><br>
Conclusion: Taking the BD and mortality measurements together, this
analysis<br>
shows that a SBP <=110 mm Hg is a more clinically relevant definition
of<br>
hypotension and hypoperfusion than is 90 mm Hg. This analysis will also
be<br>
useful for developing appropriately powered studies of hemorrhagic
shock.<br>
<<a href="http://www.state.nj.us/health/ems/documents/imp_info.pdf" eudora="autourl">
http://www.state.nj.us/health/ems/documents/imp_info.pdf</a>><br>
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