Hypotension During Vasopressor Infusion Occurs in Predictable Clusters: A Multicenter Analysis.

Background: Published evidence indicates that mean arterial pressure (MAP) below a goal range (hypotension) is associated with worse outcomes, though MAP management failures are common. We sought to characterize hypotension occurrences in ICUs and consider the implications for MAP management. Methods: Retrospective analysis of 3 hospitals' cohorts of adult ICU patients during continuous vasopressor infusion. Two cohorts were general, mixed ICU patients and one was exclusively acute spinal cord injury patients. "Hypotension-clusters" were defined where there were ≥10 min of cumulative hypotension over a 60-min period and "constant hypotension" was ≥10 continuous minutes. Trend analysis was performed (predicting future MAP using 14 min of preceding MAP data) to understand which hypotension-clusters could likely have been predicted by clinician awareness of MAP trends. Results: In cohorts of 155, 66, and 16 ICU stays, respectively, the majority of hypotension occurred within the hypotension-clusters. Failures to keep MAP above the hypotension threshold were notable in the bottom quartiles of each cohort, with hypotension durations of 436, 167, and 468 min, respectively, occurring within hypotension-clusters per day. Mean arterial pressure trend analysis identified most hypotension-clusters before any constant hypotension occurred (81.2%-93.6% sensitivity, range). The positive predictive value of hypotension predictions ranged from 51.4% to 72.9%. Conclusions: Across 3 cohorts, most hypotension occurred in temporal clusters of hypotension that were usually predictable from extrapolation of MAP trends.

Predicting Hypertensive Events with Time-Series Analysis of Mean Arterial Pressure.

We investigated whether a statistical model used previously to predict hypotension from mean arterial pressure (MAP) time series analysis could predict hypertension. We performed a retrospective analysis of minute-by-minute MAP records from two cohorts of intensive care unit (ICU) patients. The first cohort was comprised of surgical and medical ICUs while the second cohort was comprised of acute spinal cord injury (ASCI) patients in a neurological ICU. At each time point with physiological MAP, time series analysis was used to predict the median MAP for the subsequent 20 min. This method was used to predict hypertensive episodes, i.e., intervals of 20 or more minutes where at least half of the MAP measurements were > 105 mmHg. Advance prediction of hypertensive episodes was similar in the two cohorts (69.15% vs. 82.61%, respectively), as was positive predictive value of the hypertension predictions (67.42% vs. 71.57%). The results suggest that the methodology may be useable for predicting hypertension from time-series analysis of MAP. Patients requiring continuous vasopressor infusion are at risk of hypertension and excessive vasoconstriction. We found evidence that time-series analysis previously validated for predicting hypotension may also be usable for predicting hypertension.

Monolithic poly(butyl methacrylate-ethylene dimethacrylate-methacrylic acid) column for capillary electrochromatography.

A butyl methacrylate-ethylene dimethacrylate-methacrylic acid (MAA) monolithic column was prepared for capillary electrochromatography. The effect of MAA weight percentage on the EOF mobility and column efficiency was studied. BMA-EDMA-MAA monolith with higher content of MAA provided higher EOF mobility as well as higher efficiency. The effect of mobile-phase composition and buffer pH was also investigated. The monolithic columns exhibited a good repeatability and reproducibility of column preparation with relative standard deviation values below 16% in the studied chromatographic parameters.

Characterization and comparison of methacrylic acid with 2-acrylamido-2-methyl-1-propanesulfonic acid in the preparation of monolithic column for capillary electrochromatography.

Butyl methacrylate (BMA)-ethylene dimethacrylate (EDMA)-methacrylic acid (MAA) and BMA-EDMA-2-acrylamido-2-methyl-1-propanesulfonic acid (AMPS) monolithic columns were prepared by varying the percentage of ionic monomers for capillary electrochromatography. Monolithic columns with a higher content of ionic monomers provided better column efficiency, and the performance of BMA-EDMA-MAA monoliths was better than BMA-EDMA-AMPS. To characterize and optimize BMA-EDMA-MAA monoliths, the effects of the content of cross-linker and the total monomer in the polymerization mixture on column performance were also studied. Plate heights of 8.2 µm for the unretained solute (thiourea) and 12.6 µm for the retained solute (naphthalene) were achieved with a monolithic column using 2.5% MAA (Column I).