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Evaluation of blood pressure trajectories versus outcome in critically ill children with initial hypertension on admission to Paediatric Intensive Care

Peros, Thomas; Ricciardi, Federico; Booth, John; Ray, Samiran; Peters, Mark J; (2022) Evaluation of blood pressure trajectories versus outcome in critically ill children with initial hypertension on admission to Paediatric Intensive Care. Anaesthesia Critical Care & Pain Medicine , 41 (6) , Article 101149. 10.1016/j.accpm.2022.101149. Green open access

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Abstract

OBJECTIVE: Hypertension on paediatric intensive care (PICU) is associated with adverse outcomes. Management is complex; hypertension often represents a physiological adaptive response and exposure to hypertension could lead to altered pressure-flow autoregulation. International treatment consensus is to avoid rapid blood pressure (BP) reduction. Our aim was to examine if the rate and magnitude of BP reduction in hypertensive patients was correlated with harm. PATIENTS AND METHODS: We performed a single centre, retrospective, observational study in a quaternary PICU analysing the first 24 hours post admission high resolution BP profiles of children with admission BP above the 95th centile. Individual BP profiles were analysed regarding both time spent and magnitude below a threshold; 75% of the admission BP in the first 24 hours. Outcomes were organ support-free days at day 28, change in serum creatinine and PICU mortality. MAIN FINDINGS: Of 3069 admissions in a 36-month period (2016-2018), 21.7% had initial hypertension on admission to PICU. A total of 3,259,111 BP measurements (99.4% invasive) were available. Pre-existing hypertension was documented in 4.9% of patients. Both time spent and magnitude below threshold BP was poorly correlated with duration of required organ support and risk of death after adjusting for PIM score, pre-existing hypertension and raised intracranial pressure. We did find an association with a rise in serum creatinine on both uni- and multivariable analysis. CONCLUSIONS: The risk of harm due to early and significant reduction of raised blood pressure in critically ill children appears to be limited.

Type: Article
Title: Evaluation of blood pressure trajectories versus outcome in critically ill children with initial hypertension on admission to Paediatric Intensive Care
Location: France
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.accpm.2022.101149
Publisher version: https://doi.org/10.1016/j.accpm.2022.101149
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: acute kidney injury, adolescent, child, critical illness, hypertension, mortality
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10156896
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