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 Schuurmans; J Schenk; S Roerhorst; T G V Cherpanath; W K Lagrand; P Thoral; P W G Elbers; P R Tuinman; T W L Scheeren; J Bakker; B F Geerts; D P Veelo; F Paulus; A P J Vlaar; Cardiovascular Dynamics Section of the ESICM

doi:10.1016/j.jcrc.2021.10.008

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

J Crit Care. 2022 Feb:67:118-125. doi: 10.1016/j.jcrc.2021.10.008. Epub 2021 Nov 5.

Authors

Affiliations

¹ Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands.
² Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands.
³ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity, De Boelelaan 1117, Amsterdam, Netherlands.
⁴ University Medical Center Groningen, University of Groningen, Department of Anesthesiology, Groningen, Netherlands.
⁵ New York University Langone Medical Center, New York University Langone Health, Department of Pulmonary and Critical Care, New York, USA; Columbia University Medical Center, Columbia University, Department of Pulmonology and Critical Care, New York, USA; Erasmus MC University Medical Center, Erasmus University, Department of Intensive Care, Rotterdam, Netherlands; Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Departamento de Medicina Intensiva, Santiago, Chile.
⁶ Spaarne Gasthuis, Department of Intensive Care, Haarlem, Netherlands.
⁷ Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands.
⁸ Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands. Electronic address: [email protected].

PMID: 34749051
DOI: 10.1016/j.jcrc.2021.10.008

Abstract

Introduction: 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.

Methods: We conducted an international survey among ICU personnel to provide insight in monitoring, management, and perceived consequences of hypotension.

Results: 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%).

Conclusions: 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.

Keywords: Complications; Critical care; Hypotension; Nursing care; Outcome; Surveys and questionnaires.

MeSH terms

Critical Care
Humans
Hypotension* / therapy
Intensive Care Units
Physicians*
Surveys and Questionnaires