Monitoring, management, and outcome of hypotension in Intensive Care Unit patients, an international survey of the European Society of Intensive Care Medicine.

W.H Van Der Ven,J Schenk,J Bakker,B.F Geerts,A.P.J Vlaar,J Schuurmans,D.P Veelo,S Roerhorst,P.R Tuinman,F Paulus,T.G.V Cherpanath,P.W.G Elbers,T.W.L Scheeren,P Thoral,W.K Lagrand

doi:10.1016/j.jcrc.2021.10.008

Abstract

Hypotension in the ICU is common, yet management is challenging and variable. Insight in management by ICU physicians and nurses may improve patient care and guide future hypotension treatment trials and guidelines. We conducted an international survey among ICU personnel to provide insight in monitoring, management, and perceived consequences of hypotension. Out of 1464 respondents, 1197 (81.7%) were included (928 physicians (77.5%) and 269 nurses (22.5%)). The majority indicated that hypotension is underdiagnosed (55.4%) and largely preventable (58.8%). Nurses are primarily in charge of monitoring changes in blood pressure, physicians are in charge of hypotension treatment. Balanced crystalloids, dobutamine, norepinephrine, and Trendelenburg position were the most frequently reported fluid, inotrope, vasopressor, and positional maneuver used to treat hypotension. Reported complications believed to be related to hypotension were AKI and myocardial injury. Most ICUs do not have a specific hypotension treatment guideline or protocol (70.6%), but the majority would like to have one in the future (58.1%). Both physicians and nurses report that hypotension in ICU patients is underdiagnosed, preventable, and believe that hypotension influences morbidity. Hypotension management is generally not protocolized, but the majority of respondents would like to have a specific hypotension management protocol.

Highlights

IntroductionInsight in management by Intensive Care Unit (ICU) physicians and nurses may improve patient care and guide future hypotension treatment trials and guidelines
Hypotension in the Intensive Care Unit (ICU) is common, yet management is challenging and variable
Insight in the opinion of ICU physicians and nurses regarding monitoring, preferred management, and perceived consequences of hypotensive events, could improve patient care, facilitate uniformity in future trials, and aid in conceptualization of guidelines. In this questionnaire among critical care personnel, we surveyed current practice of monitoring and management of hypotension in ICU patients and assessed their opinion regarding the influence of hypotension on outcome

Summary

Introduction

Insight in management by ICU physicians and nurses may improve patient care and guide future hypotension treatment trials and guidelines. Conclusions: Both physicians and nurses report that hypotension in ICU patients is underdiagnosed, preventable, and believe that hypotension influences morbidity. Insight in the opinion of ICU physicians and nurses regarding monitoring, preferred management, and perceived consequences of hypotensive events, could improve patient care, facilitate uniformity in future trials, and aid in conceptualization of guidelines. In this questionnaire among critical care personnel, we surveyed current practice of monitoring and management of hypotension in ICU patients and assessed their opinion regarding the influence of hypotension on outcome

Methods

Results

Discussion

Conclusion