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

OBJECTIVES: Maintenance of mean arterial pressure>65 mm Hg has been associated with improved clinical outcomes in many studies of critically ill patients. Current guidelines for the management of septic shock and guidelines for managing other critical illnesses suggest intra-arterial blood pressure measurement is preferred over automated oscillometric noninvasive blood pressure measurement. Despite these recommendations, anecdotal experience suggested that the use of noninvasive blood pressure measurement in our institution and others in preference to intra-arterial blood pressure measurement remained prevalent. DESIGN: We designed an online survey and sent it by e-mail. SETTING: Intensive care units. PATIENTS AND SUBJECTS: A randomly selected group from the membership of the Society for Critical Care Medicine. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Use of non-invasive and invasive blood pressure devices. Eight hundred eighty individuals received an invitation to complete the survey and 149 responded. We found that 71% (105 of 149) of intensivists estimated the correct cuff size rather than measuring arm circumference directly. In hypotensive patients, 73% of respondents (108 of 149) reported using noninvasive blood pressure measurement measurements for patient management. In patients on a vasopressor medication, 47% (70 of 149) of respondents reported using noninvasive blood pressure measurement for management. CONCLUSIONS: The use of noninvasive blood pressure measurement measurements in critically ill patients is common despite the paucity of evidence validating its accuracy in critically ill patients. Given this widespread use, accuracy and precision validation studies comparing noninvasive blood pressure measurement with intra-arterial blood pressure measurement in critically ill patients should be performed.

Capsule endoscopy removal through flexible bronchoscopy.

Since its introduction over 9 years ago, capsule video endoscopy has become increasingly popular within the gastroenterology community, leading to its use in a growing number of patients including the elderly. With the widespread adoption of this diagnostic modality within the elderly population comes the added risk of capsule aspiration. We present such a case where a 90-year-old patient was admitted after accidental aspiration of a capsule. Removal of the capsule posed a therapeutic challenge. In the article, we discuss the novel use of a Roth Net expandable foreign body extractor to remove the capsule using a flexible bronchoscope with minimal need for sedation. As video capsule endoscopy is used more routinely in elderly patients and clinical pulmonologists will be more frequently called up to assist in foreign body removal, our experience highlights that it is possible to remove these large capsules with a flexible bronchoscope and avoid the need for rigid bronchoscopy in this high-risk patient group.