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Average arterial pressure (MAP) is critical for patients with cirrhosis in the Intensive Care Unit (ICU), but data on guiding treatment and target values are limited.
, 22 June, a study published online in the journal Crit Care Med (IF-7.414) examined the association between MAP and poor outcomes in ICU patients with severe cirrhosis.
study outlined this retrospective observational study included 273 critical lysis patients with cirrhosis.
the study conducted a comprehensive analysis of the time-weighted mean arterial pressure (TWA-MAP) (TWA-MAP and the cumulative time below the various MAP thresholds) within the first 24 hours of staying in the ICU (the median arterial pressure assessment for each patient was 25h).
TWA-MAP records the low blood pressure level and duration below the MAP threshold, and the total time below the MAP threshold (i.e. the cumulative time below the threshold).
use single-variable and multivariate regression analysis models to assess the effect of cumulative times below TWA-MAP and MAP thresholds (55, 60, 65, 70, and 75 mmHg) on ICU mortality.
the results of the study results of the analysis results: ? TWA-MAP: When THE MAP falls below the threshold of 75, 70, 65, 60 and 55 mmHg, TWA-MAP drops by 1 mmHg, and the icU death probability is 14%, 18%, 26%, 41% and 74% respectively (p.lt; 0.01, all thresholds).
the correlation between TWA-MAP and ICU mortality rates at each threshold remained significant after correcting sodium sodium scoring, mechanical ventilation, riser in use, renal replacement therapy, 3/4 level sepsis of hepatic encephalopathy, white blood cell count, and albumin.
? Accumulation time below the MAP threshold: when the time below the 75, 70, 65, 60 and 55 mmHg thresholds is 1h, the ICU probability of death is 4%, 6%, 10%, 12% and 12%, respectively.
in the corrected model, there is a significant correlation only when the MAP threshold is below 65 mmHg (ratio, 1.07; 95% CI, 1.00-1.14; p- 0.05) and .lt; 60 mmHg (ratio ratio, 1.10; 95% CI, 1.01-18; p s 0.04).
the findings of these studies, maintaining MAP-65 mmHg may be a reasonable target value for patients with cirrhosis living in the ICU.
however, further prospective randomized trials are needed to determine the optimal MAP target value for the patient population.
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