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    Trigger characteristics of EUSIG-defined hypotensive events.

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    3
    Author
    Donald, R; Howells, T; Piper, I; Chambers, I; Citerio, G; Enblad, P; Gregson, B; Kiening, K; Mattern, J; Nilsson, P; ...
    Date
    2012
    Source Title
    Acta Neurochir Suppl
    Publisher
    Springer Verlag
    University of Melbourne Author/s
    Sinnott, Richard; Stell, Anthony
    Affiliation
    Computing And Information Systems
    Metadata
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    Document Type
    Conference Paper
    Citations
    Donald, R., Howells, T., Piper, I., Chambers, I., Citerio, G., Enblad, P., Gregson, B., Kiening, K., Mattern, J., Nilsson, P., Ragauskas, A., Sahuquillo, J., Sinnott, R. & Stell, A. (2012). Trigger characteristics of EUSIG-defined hypotensive events.. Acta Neurochir Suppl, 114, (114), pp.45-49. Springer Verlag. https://doi.org/10.1007/978-3-7091-0956-4_9.
    Access Status
    This item is currently not available from this repository
    URI
    http://hdl.handle.net/11343/32509
    DOI
    10.1007/978-3-7091-0956-4_9
    Description

    F1 - Full Written Papers Refereed

    Abstract
    BACKGROUND: Hypotension is a recognized -secondary insult after traumatic brain injury (TBI). There are many definitions of hypotension, an often cited example being the Brain Trauma Foundation's current (2007) "Guidelines for the Management of Severe Traumatic Brain Injury," which defines hypotension as systolic pressure <90 mmHg. However, this same document declares "The importance of mean arterial pressure, as opposed to systolic pressure should also be stressed, …." Our work shows that when using the Edinburgh University Secondary Insult Grades (EUSIG) definitions, which require monitoring of both systolic and mean arterial pressures, that most hypotensive events are in fact triggered by a breach of the mean arterial level of 70 mmHg. We suggest that close monitoring of mean arterial pressure would enable clinical teams to avoid more potentially damaging hypotensive events. MATERIALS AND METHODS: An analysis of 100 patients from the Brain-IT database was performed. Using the EUSIG definitions, 2,081 events can be obtained by analyzing the systolic and mean blood pressures on a minute by minute basis. A software program was written to identify and classify the trigger pattern for each event. A categorical analysis of these triggering patterns has been carried out. KEY RESULTS: Our analysis shows that most events are triggered by a drop in mean arterial pressure. In fact a large number of events (91%) occur where the mean arterial pressure is below the threshold limits whereas the systolic pressure does not cross the 90 mmHg limit at all. CONCLUSION: We suggest that more emphasis should be placed on closely monitoring mean arterial pressure as well as systolic pressure when trying to guard against hypotensive problems in traumatically brain injured patients. In future work we will study the underlying physiological mechanisms and attempt to further classify concomitant conditions that may be contributing to the onset of a hypotensive event.
    Keywords
    Bioinformatics Software; Health and Support Services not elsewhere classified

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