Monitoring, management, and outcome of hypotension in Intensive Care Unit patients, an international survey of the European Society of Intensive Care Medicine
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 monit...
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| Veröffentlicht in: | Journal of critical care 2022-02, Vol.67, p.118-125 |
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| creator | van der Ven, W.H. Schuurmans, J. Schenk, J. Roerhorst, S. Cherpanath, T.G.V. Lagrand, W.K. Thoral, P. Elbers, P.W.G. Tuinman, P.R. Scheeren, T.W.L. Bakker, J. Geerts, B.F. Veelo, D.P. Paulus, F. Vlaar, A.P.J. |
| description | 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.
•According to the majority of ICU physicians and nurses, hypotensive events are underdiagnosed and preventable.•Nurses are in charge of monitoring changes in blood pressure, whereas physicians are in charge of treating hypotension.•Most respondents indicated that hypotension management should be improved in their ICU.•Frequently reported complications believed to be related to hypotension were acute kidney injury and myocardial injury.•Most ICUs do not have a hypotension treatment protocol, but the majority of the respondents would like to have one. |
| doi_str_mv | 10.1016/j.jcrc.2021.10.008 |
| format | Article |
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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.
•According to the majority of ICU physicians and nurses, hypotensive events are underdiagnosed and preventable.•Nurses are in charge of monitoring changes in blood pressure, whereas physicians are in charge of treating hypotension.•Most respondents indicated that hypotension management should be improved in their ICU.•Frequently reported complications believed to be related to hypotension were acute kidney injury and myocardial injury.•Most ICUs do not have a hypotension treatment protocol, but the majority of the respondents would like to have one.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2021.10.008</identifier><identifier>PMID: 34749051</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anesthesiology ; Blood pressure ; Complications ; Critical Care ; Humans ; Hypotension ; Hypotension - therapy ; Intensive care ; Intensive Care Units ; Laboratories ; Nurses ; Nursing care ; Outcome ; Physicians ; Polls & surveys ; Questionnaires ; Surveys and Questionnaires ; Ventilators</subject><ispartof>Journal of critical care, 2022-02, Vol.67, p.118-125</ispartof><rights>2021 The Author(s)</rights><rights>Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.</rights><rights>2021. The Author(s)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-86df4406ed7e9aeedb4e170a61019d6fe42f3ee28f342924d1b09f69903a39213</citedby><cites>FETCH-LOGICAL-c428t-86df4406ed7e9aeedb4e170a61019d6fe42f3ee28f342924d1b09f69903a39213</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S088394412100232X$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34749051$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Ven, W.H.</creatorcontrib><creatorcontrib>Schuurmans, J.</creatorcontrib><creatorcontrib>Schenk, J.</creatorcontrib><creatorcontrib>Roerhorst, S.</creatorcontrib><creatorcontrib>Cherpanath, T.G.V.</creatorcontrib><creatorcontrib>Lagrand, W.K.</creatorcontrib><creatorcontrib>Thoral, P.</creatorcontrib><creatorcontrib>Elbers, P.W.G.</creatorcontrib><creatorcontrib>Tuinman, P.R.</creatorcontrib><creatorcontrib>Scheeren, T.W.L.</creatorcontrib><creatorcontrib>Bakker, J.</creatorcontrib><creatorcontrib>Geerts, B.F.</creatorcontrib><creatorcontrib>Veelo, D.P.</creatorcontrib><creatorcontrib>Paulus, F.</creatorcontrib><creatorcontrib>Vlaar, A.P.J.</creatorcontrib><creatorcontrib>on behalf of the Cardiovascular Dynamics Section of the ESICM</creatorcontrib><creatorcontrib>Cardiovascular Dynamics Section of the ESICM</creatorcontrib><title>Monitoring, management, and outcome of hypotension in Intensive Care Unit patients, an international survey of the European Society of Intensive Care Medicine</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>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.
•According to the majority of ICU physicians and nurses, hypotensive events are underdiagnosed and preventable.•Nurses are in charge of monitoring changes in blood pressure, whereas physicians are in charge of treating hypotension.•Most respondents indicated that hypotension management should be improved in their ICU.•Frequently reported complications believed to be related to hypotension were acute kidney injury and myocardial injury.•Most ICUs do not have a hypotension treatment protocol, but the majority of the respondents would like to have one.</description><subject>Anesthesiology</subject><subject>Blood pressure</subject><subject>Complications</subject><subject>Critical Care</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Hypotension - therapy</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Laboratories</subject><subject>Nurses</subject><subject>Nursing care</subject><subject>Outcome</subject><subject>Physicians</subject><subject>Polls & surveys</subject><subject>Questionnaires</subject><subject>Surveys and Questionnaires</subject><subject>Ventilators</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kb1uFDEUhS0EIkvgBSiQJRqK7OK_-bFEg1YBIiWigNSW13Mn8WjGXmzPSvsyPCt3soEiBZXlo-8c6Z5DyFvONpzx-uOwGVxyG8EER2HDWPuMrHhVNeu25tVzsmJtK9daKX5GXuU8MMYbKauX5EyqRmlW8RX5fRODLzH5cHdBJxvsHUwQygW1oaNxLi5OQGNP74_7WCBkHwP1gV6Fh88B6NYmoLeYQfe2eLTmxYtMgRRQicGONM_pAMclp9wDvZxT3ANCP6LzUB70J4E30HnnA7wmL3o7Znjz-J6T2y-XP7ff1tffv15tP1-vnRJtwXu7XilWQ9eAtgDdTgFvmK2xJ93VPSjRSwDR9lIJLVTHd0z3tdZMWqkFl-fkwyl3n-KvGXIxk88OxtEGiHM2otJVVWOBCtH3T9AhznjqiFTNWqWQk0iJE-VSzDlBb_bJTzYdDWdmWc8MZlnPLOstGq6HpneP0fNugu6f5e9cCHw6AYBdHDwkk7HB4LCtBK6YLvr_5f8Buems7g</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>van der Ven, W.H.</creator><creator>Schuurmans, J.</creator><creator>Schenk, J.</creator><creator>Roerhorst, S.</creator><creator>Cherpanath, T.G.V.</creator><creator>Lagrand, W.K.</creator><creator>Thoral, P.</creator><creator>Elbers, P.W.G.</creator><creator>Tuinman, P.R.</creator><creator>Scheeren, T.W.L.</creator><creator>Bakker, J.</creator><creator>Geerts, B.F.</creator><creator>Veelo, D.P.</creator><creator>Paulus, F.</creator><creator>Vlaar, A.P.J.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202202</creationdate><title>Monitoring, management, and outcome of hypotension in Intensive Care Unit patients, an international survey of the European Society of Intensive Care Medicine</title><author>van der Ven, W.H. ; Schuurmans, J. ; Schenk, J. ; Roerhorst, S. ; Cherpanath, T.G.V. ; Lagrand, W.K. ; Thoral, P. ; Elbers, P.W.G. ; Tuinman, P.R. ; Scheeren, T.W.L. ; Bakker, J. ; Geerts, B.F. ; Veelo, D.P. ; Paulus, F. ; Vlaar, A.P.J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-86df4406ed7e9aeedb4e170a61019d6fe42f3ee28f342924d1b09f69903a39213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anesthesiology</topic><topic>Blood pressure</topic><topic>Complications</topic><topic>Critical Care</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Hypotension - 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Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Ven, W.H.</au><au>Schuurmans, J.</au><au>Schenk, J.</au><au>Roerhorst, S.</au><au>Cherpanath, T.G.V.</au><au>Lagrand, W.K.</au><au>Thoral, P.</au><au>Elbers, P.W.G.</au><au>Tuinman, P.R.</au><au>Scheeren, T.W.L.</au><au>Bakker, J.</au><au>Geerts, B.F.</au><au>Veelo, D.P.</au><au>Paulus, F.</au><au>Vlaar, A.P.J.</au><aucorp>on behalf of the Cardiovascular Dynamics Section of the ESICM</aucorp><aucorp>Cardiovascular Dynamics Section of the ESICM</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Monitoring, management, and outcome of hypotension in Intensive Care Unit patients, an international survey of the European Society of Intensive Care Medicine</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2022-02</date><risdate>2022</risdate><volume>67</volume><spage>118</spage><epage>125</epage><pages>118-125</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><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.
•According to the majority of ICU physicians and nurses, hypotensive events are underdiagnosed and preventable.•Nurses are in charge of monitoring changes in blood pressure, whereas physicians are in charge of treating hypotension.•Most respondents indicated that hypotension management should be improved in their ICU.•Frequently reported complications believed to be related to hypotension were acute kidney injury and myocardial injury.•Most ICUs do not have a hypotension treatment protocol, but the majority of the respondents would like to have one.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34749051</pmid><doi>10.1016/j.jcrc.2021.10.008</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of critical care, 2022-02, Vol.67, p.118-125 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Anesthesiology Blood pressure Complications Critical Care Humans Hypotension Hypotension - therapy Intensive care Intensive Care Units Laboratories Nurses Nursing care Outcome Physicians Polls & surveys Questionnaires Surveys and Questionnaires Ventilators |
| title | Monitoring, management, and outcome of hypotension in Intensive Care Unit patients, an international survey of the European Society of Intensive Care Medicine |
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