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Tissue perfusion pressure enables continuous hemodynamic evaluation and risk prediction in the intensive care unit.
Chandrasekhar, Anand; Padrós-Valls, Raimon; Pallarès-López, Roger; Palanques-Tost, Eric; Houstis, Nicholas; Sundt, Thoralf M; Lee, Hae-Seung; Sodini, Charles G; Aguirre, Aaron D.
Afiliación
  • Chandrasekhar A; Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
  • Padrós-Valls R; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Pallarès-López R; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Palanques-Tost E; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.
  • Houstis N; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Sundt TM; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.
  • Lee HS; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Sodini CG; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.
  • Aguirre AD; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Nat Med ; 29(8): 1998-2006, 2023 08.
Article en En | MEDLINE | ID: mdl-37550417
ABSTRACT
Treatment of circulatory shock in critically ill patients requires management of blood pressure using invasive monitoring, but uncertainty remains as to optimal individual blood pressure targets. Critical closing pressure, which refers to the arterial pressure when blood flow stops, can provide a fundamental measure of vascular tone in response to disease and therapy, but it has not previously been possible to measure this parameter routinely in clinical care. Here we describe a method to continuously measure critical closing pressure in the systemic circulation using readily available blood pressure monitors and then show that tissue perfusion pressure (TPP), defined as the difference between mean arterial pressure and critical closing pressure, provides unique information compared to other hemodynamic parameters. Using analyses of 5,988 admissions to a modern cardiac intensive care unit, and externally validated with 864 admissions to another institution, we show that TPP can predict the risk of mortality, length of hospital stay and peak blood lactate levels. These results indicate that TPP may provide an additional target for blood pressure optimization in patients with circulatory shock.
Asunto(s)

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Choque / Unidades de Cuidados Intensivos Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Nat Med Asunto de la revista: BIOLOGIA MOLECULAR / MEDICINA Año: 2023 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Choque / Unidades de Cuidados Intensivos Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Nat Med Asunto de la revista: BIOLOGIA MOLECULAR / MEDICINA Año: 2023 Tipo del documento: Article