Subject(s)
Aorta, Thoracic/injuries , Blood Vessel Prosthesis Implantation/instrumentation , Organ Sparing Treatments/methods , Subclavian Artery/surgery , Wounds, Nonpenetrating/surgery , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Computed Tomography Angiography , Humans , Injury Severity Score , Lasers, Excimer/adverse effects , Patient Care Planning , Stents , Treatment Outcome , Wounds, Nonpenetrating/diagnosisABSTRACT
OBJECTIVES: Blood pressure (BP) measurement is essential for managing patients with hypotension. There are differences between invasive arterial blood pressure (IABP) and noninvasive blood pressure (NIBP) measurements. However, the clinical applicability of these differences in patients with shock [need for vasopressor or serum lactate ≥ 4 millimole per liter (mmol/L)] has not been reported. This study investigated differences in IABP and NIBP as well as changes in clinical management in critically ill patients with shock. METHODS: This was a retrospective study involving adult patients admitted to the Critical Care Resuscitation Unit (CCRU). Adult patients who received IABP upon admission between 01/01/2017-12/31/2017 with non-hypertensive diseases were eligible. The primary outcome, clinically relevant difference (CRD), was defined as difference of 10 mm of mercury (mmHg) between IABP and NIBP and change of blood pressure management according to goal mean arterial pressure (MAP) ≥ 65 mmHg. We performed forward stepwise multivariable logistic regression to measure associations. RESULTS: Sample size calculation recommended 200 patients, and we analyzed 263. 121 (46%) patients had shock, 23 (9%) patients had CRD. Each mmol/L increase in serum lactate was associated with 11% higher likelihood of having CRD (OR 1.11, 95%CI 1.002-1.2). Peripheral artery disease and any kidney disease was significantly associated with higher likelihood of MAP difference ≥ 10 mmHg. CONCLUSION: Approximately 9% of patients with shock had clinically-relevant MAP difference. Higher serum lactate was associated with higher likelihood of CRD. Until further studies are available, clinicians should consider using IABP in patients with shock.
Subject(s)
Blood Pressure Determination/methods , Critical Care/methods , Resuscitation/methods , Shock/diagnosis , Arteries/physiology , Blood Pressure , Female , Humans , Lactic Acid/blood , Logistic Models , Male , Middle Aged , Retrospective Studies , Shock/blood , Shock/physiopathologyABSTRACT
Children should be at least 6 months of age and parents should provide only 100% fruit juice in a cup (not a bottle). Intake should be limited to 4 to 6 oz a day until 12 months of age. It's important to reiterate to parents that breastfeeding is the preferred source of infant nutrition for the first 6 (preferably 12) months of life. Sugar-sweetened fruit drinks have been linked to excess weight gain and obesity. Sugar-sweetened beverages provide little nutritional benefit to children and should be restricted.
