Introduction
Materials and methods
Study patients and data collection
Determination of the arterial blood pressure associated with terminal cardiovascular collapse
Study endpoints
Statistical analysis
Results
Characteristics | Patient data ( N = 140) | |
---|---|---|
Age (yr) | 72.8 ± 13.2 | |
Male sex (n (%)) | 87 (62.1) | |
Body mass index (kg/m2) | 26.1 ± 5.5 | |
Comorbid conditions (n (%)) | ||
Chronic arterial hypertension | 78 (55.7) | |
Coronary artery disease | 57 (40.7) | |
Congestive heart failure | 27 (19.3) | |
Severe aortic stenosis | 3 (2.1) | |
Chronic renal failure | 26 (18.6) | |
Diabetes mellitus | 26 (18.6) | |
Peripheral arterial occlusive disease | 15 (10.7) | |
Admission diagnosis (n (%)) | ||
Post–cardiac arrest | 26 (18.6) | |
Shock of any origin | 22 (15.7) | |
Abdominal disease | 21 (15) | |
Respiratory insufficiency | 20 (14.3) | |
Trauma | 12 (8.6) | |
Post–cardiac surgery | 10 (7.1) | |
Gastrointestinal hemorrhage | 7 (5) | |
Miscellaneous | 22 (15.6) | |
SAPS IIa (points) | 53 ± 20 | |
SAPS IIIa (points) | 73 ± 18 | |
Intensive care unit length of stay (days) | 7.1 ± 9.6 | |
Autopsy performed (n (%)) | 84 (60) |
Clinical data | ||
---|---|---|
24 hours before terminal cardiovascular collapse
| ||
Sepsis (n (%)) | 34 (24.3) | |
Sepsis focus (n (%)) | ||
Abdomen | 9 (6.4) | |
Soft tissue/joints | 7 (5) | |
Lungs | 3 (2.1) | |
Primary bacteremia | 2 (1.4) | |
Miscellaneous | 18 (9.3) | |
Shock (n (%)) | 87 (62.1) | |
Acute right heart failure (n (%)) | 22 (15.7) | |
Sequential Organ Failure Assessment score (points) | 12 ± 4 | |
At the time of terminal cardiovascular collapse
| ||
Base deficit (mmol/L) | −5.1 ± 8 | |
Arterial lactate (mmol/L) | 5.4 ± 4.8 | |
Hemoglobin (mg/dl) | 9.6 ± 1.9 | |
Partial arterial carbon dioxide tension (mmHg) | 52 ± 30 | |
Plethysmographic oxygen saturation (%) | 77 ± 16 | |
Body temperature (°C) | 36.9 ± 1.8 | |
Heart rate (beats/min) | 88 ± 24 | |
Central venous pressure (mmHg) | 14 ± 7 | |
Catecholamine infusion (n (%)) | 84 (60) | |
Vasopressin infusion (n (%)) | 6 (4.3) | |
Levosimendan infusion (n (%)) | 5 (3.6) | |
Cause of death
| ||
Cardiovascular failure (n (%)) | 84 (60) | |
Multiple organ dysfunction (n (%)) | 29 (20.7) | |
Respiratory failure (n (%)) | 15 (10.7) | |
Severe ischemic encephalopathy (n (%)) | 12 (8.6) |
Systolic arterial blood pressure | Mean arterial blood pressure | Diastolic arterial blood pressure | |||||||
---|---|---|---|---|---|---|---|---|---|
(Total population, 47 ± 17) | (Total population, 35 ± 11) | (Total population, 29 ± 9) | |||||||
Pre-defined risk factors | Risk factor | No risk factor | P -value | Risk factor | No risk factor | P -value | Risk factor | No risk factor | P -value |
Age >65 yr (n = 103) | 47 ± 17 | 47 ± 18 | 0.99 | 35 ± 11 | 34 ± 12 | 0.64 | 29 ± 9 | 28 ± 10 | 0.61 |
Age >75 yr (n = 66) | 50 ± 17 | 45 ± 17 | 0.06 | 37 ± 10 | 33 ± 11 | 0.05 | 30 ± 9 | 28 ± 10 | 0.16 |
Cardiac surgery (n = 10) | 51 ± 19 | 47 ± 17 | 0.53 | 35 ± 12 | 35 ± 11 | 0.95 | 27 ± 11 | 29 ± 9 | 0.69 |
Chronic arterial hypertension (n = 78) | 49 ± 17 | 45 ± 17 | 0.12 | 36 ± 11 | 33 ± 10 | 0.18 | 29 ± 10 | 28 ± 9 | 0.29 |
Congestive heart failure (n = 27) | 53 ± 20 | 46 ± 16 | 0.06 | 39 ± 13 | 34 ± 10 | 0.04a | 31 ± 12 | 28 ± 8 | 0.17 |
Coronary artery disease (n = 57) | 48 ± 18 | 47 ± 17 | 0.76 | 36 ± 12 | 34 ± 10 | 0.34 | 30 ± 10 | 28 ± 8 | 0.27 |
Diabetes mellitus (n = 26) | 47 ± 17 | 48 ± 17 | 0.81 | 35 ± 11 | 35 ± 11 | 0.98 | 29 ± 9 | 28 ± 9 | 0.71 |
Left main stem stenosis (n = 23) | 53 ± 16 | 46 ± 17 | 0.08 | 39 ± 11 | 34 ± 11 | 0.03a | 32 ± 10 | 28 ± 9 | 0.07 |
PAODb (n = 15) | 43 ± 17 | 48 ± 17 | 0.34 | 33 ± 10 | 35 ± 11 | 0.63 | 27 ± 8 | 29 ± 9 | 0.62 |
Acute right heart failure (n = 22) | 53 ± 20 | 46 ± 16 | 0.1 | 39 ± 13 | 34 ± 10 | 0.03a | 32 ± 11 | 28 ± 9 | 0.06 |
Sepsis (n = 34) | 42 ± 12 | 49 ± 18 | 0.005a | 30 ± 8 | 36 ± 11 | 0.001a | 25 ± 8 | 30 ± 9 | 0.02a |
Severe aortic stenosis (n = 3) | 60 ± 20 | 47 ± 17 | 0.2 | 46 ± 12 | 34 ± 11 | 0.08 | 36 ± 10 | 28 ± 9 | 0.16 |
Shock (n = 87) | 48 ± 17 | 47 ± 17 | 0.73 | 35 ± 11 | 34 ± 10 | 0.36 | 29 ± 10 | 27 ± 8 | 0.14 |
Cofactor | Systolic arterial blood pressure | Mean arterial blood pressure | Diastolic arterial blood pressure | |||
---|---|---|---|---|---|---|
Pearson coefficient | P -value | Pearson coefficient | P -value | Pearson coefficient | P -value | |
Age (yr) | 0.1 | 0.24 | 0.11 | 0.2 | 0.07 | 0.38 |
SpO2 (%) | −0.06 | 0.54 | 0.02 | 0.82 | 0.05 | 0.63 |
Temperature (°C) | −0.08 | 0.41 | −0.09 | 0.31 | −0.13 | 0.17 |
Hemoglobin (g/dl) | 0.03 | 0.69 | 0.04 | 0.69 | <0.01 | 0.99 |
PaCO2 (mmHg) | 0.15 | 0.08 | 0.08 | 0.38 | 0.03 | 0.7 |
SOFA score (points) | −0.04 | 0.61 | 0.06 | 0.48 | 0.14 | 0.11 |
Sedative and/or opioid exposure | −0.17 | 0.048b | −0.185 | 0.03b | −0.16 | 0.06 |
Discussion
Conclusions
Key messages
-
The arterial blood pressure associated with terminal cardiovascular collapse in critically ill patients was very low at 47 ± 12 mmHg systolic, 35 ± 11 mmHg mean and 29 ± 9 mmHg diastolic arterial blood pressure.
-
Relevant exceptions were patients with congestive heart failure, left main stem stenosis, severe valvular aortic stenosis or acute right heart failure.
-
Sepsis patients and patients receiving sedatives and/or opioids exhibited even lower arterial blood pressures at terminal cardiovascular collapse.