PURPOSE: To evaluate the clinical significance of mean arterial blood pressure (MAP) in predicting the mortality of patients admitted to our medical intensive care unit (MICU). We hypothesize that low MAP at admission to MICU is associated with increased mortality.
METHODS: All patients admitted to the MICU in a six-month period were consecutively entered into a prospective cohort study. Those with age less than 18 years, incomplete medical records, do-not-resuscitate status, a prior history of hypertension and pregnant patients were excluded. Patients’ demographic information, MAP on MICU admission, APACHE II scores, ventilator days, MICU and hospital length of stay were documented. Patients were followed until 28 days from the day of MICU admission and their discharge or death were documented with in this period. Survivors were then compared to non-survivors.
RESULTS: 273 patients were enrolled, 170 males and 103 females, with mean age of 60.4 +/- 18.3 years. Overall in-hospital mortality was 45.8%. Mortality was significantly lower in patients with MAP ≥ 70 mmHg when compared to those with MAP < 70 mmHg (p= 0.007). There was no statistically significant difference between groups with MAP 61–65 mmHg and 66–70 mmHg (p=0.09).
CONCLUSION: A low MAP can be a crude predictor of mortality, thus we suggest close monitoring of patients in general wards and emergency room. Early goal directed therapy aiming for MAP greater than 70 mmHg might reduce mortality. Additionally, focusing on educating the house staff and other health care workers about early warning signs such as low MAP may ensure a timely and appropriate response.
CLINICAL IMPLICATIONS: Unexpected in-hospital cardiac arrest or death is often preceded by signs of clinical instability. Similarly, unforeseen admissions to intensive care units are commonly forecast by abnormalities in vital signs without suitable action being taken. Early goal oriented interventions in response to these physiological signs might prevent further deterioration in many patients.
DISCLOSURE: Sandeep Bansal, No Financial Disclosure Information; No Product/Research Disclosure Information