Merci, intéressant.
*Martin Chénier*
/[EMAIL PROTECTED]/
Alain Vadeboncoeur a écrit :
Intéressante définition de l'hypotension.
Alain
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[EMAIL PROTECTED] On Behalf Of Jel Coward
Sent: 2 septembre 2007 22:00
To: [EMAIL PROTECTED]
Subject: Hypotension
Hypotension Begins at 110 mm Hg: Redefining "Hypotension" With Data.
Original Articles
Journal of Trauma-Injury Infection & Critical Care. 63(2):291-299, August
2007.
Eastridge, Brian J. MD; Salinas, Jose PhD; McManus, John G. MD; Blackburn,
Lorne MD; Bugler, Eileen M. MD; Cooke, William H. PhD; Concertino, Victor A.
PhD; Wade, Charles E. PhD; Holcomb, John B. MD
Abstract:
Background: Clinicians routinely refer to hypotension as a systolic blood
pressure (SBP) <=90 mm Hg. However, few data exist to support the rigid
adherence to this arbitrary cutoff. We hypothesized that the physiologic
hypoperfusion and mortality outcomes classically associated with hypotension
were manifest at higher SBPs.
Methods: A total of 870,634 patient records from the National Trauma Data
Bank with emergency department SBP and mortality data were analyzed.
Patients (140,898) with severe head injuries, a Glasgow Coma Score <=8, and
base deficit (BD) <5, or missing data items were excluded from analysis.
Admission BD, as a measure of metabolic hypoperfusion, was evaluated in
81,134 patients and mortality was plotted against SBP.
Results: Baseline mortality was <2.5%. However, at 110 mm Hg, the slope of
the mortality curve increased such that mortality was 4.8% greater for every
10-mm Hg decrement in SBP. This effect was consistent to a maximum of 26%
mortality at a SBP of 60 mm Hg. Hypoperfusion (change in the slope of BD
curve) began to increase above baseline of 4.5 at a SBP 118 mm Hg.
Conclusion: Taking the BD and mortality measurements together, this analysis
shows that a SBP <=110 mm Hg is a more clinically relevant definition of
hypotension and hypoperfusion than is 90 mm Hg. This analysis will also be
useful for developing appropriately powered studies of hemorrhagic shock.
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