Scientific Reports (Aug 2017)

Hypotension in ICU Patients Receiving Vasopressor Therapy

  • Bryce Yapps,
  • Sungtae Shin,
  • Ramin Bighamian,
  • Jill Thorsen,
  • Colleen Arsenault,
  • Sadeq A. Quraishi,
  • Jin-Oh Hahn,
  • Andrew T. Reisner

DOI
https://doi.org/10.1038/s41598-017-08137-0
Journal volume & issue
Vol. 7, no. 1
pp. 1 – 10

Abstract

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Abstract Vasopressor infusion (VPI) is used to treat hypotension in an ICU. We studied compliance with blood pressure (BP) goals during VPI and whether a statistical model might be efficacious for advance warning of impending hypotension, compared with a basic hypotension threshold alert. Retrospective data were obtained from a public database. Studying adult ICU patients receiving VPI at submaximal dosages, we analyzed characteristics of sustained hypotension episodes (>15 min) and then developed a logistic regression model to predict hypotension episodes using input features related to BP trends. The model was then validated with prospective data. In the retrospective dataset, 102-of-215 ICU stays experienced >1 hypotension episode (median of 2.5 episodes per day in this subgroup). When trained with 75% of retrospective dataset, testing with the remaining 25% of the dataset showed that the model and the threshold alert detected 99.6% and 100% of the episodes, respectively, with median advance forecast times (AFT) of 12 and 0 min. In a second, prospective dataset, the model detected 100% of 26 episodes with a median AFT of 22 min. In conclusion, episodes of hypotension were common during VPI in the ICU. A logistic regression model using BP temporal trend features predicted the episodes before their onset.