Poor blood pressure control during ICU clevidipine infusion (median 5.6% time above target) was significantly associated with prolonged up-titration intervals and failed weans (p < 0.00001).
Suboptimal clinician management practices, such as prolonged up-titration intervals and failed weans, are significantly associated with poor blood pressure control during clevidipine infusion in the ICU.
Absolute Event Rate: 0% vs 0%
Introduction: During intensive care unit (ICU) care, optimal management of hypertension is crucial for enhancing patient clinical outcomes and mitigating the risk of adverse events. Our study sought to identify clinical factors associated with hypertension among ICU patients during their treatment with clevidipine, an ultra-short-acting dihydropyridine calcium channel blocker. Methods: We conducted a retrospective single-center study, analyzing electronic medical record (EMR) data of ICU patients during clevidipine infusion. We sourced continuous arterial catheter blood pressure (BP) data from the Philips Capsule data archiving system. Individualized BP target ranges (systolic BP and/or mean arterial pressure) were determined from provider orders. The primary outcome was poor BP control defined as the percentage of time a patient’s BP was above the target range. We applied linear regression to examine how patient characteristics and clevidipine dosing practices were associated with the outcome. Results: Our study cohort was comprised of 105 adult ICU patients, with a median age of 62 years (IQR 50.5 – 72). They were admitted for non-operative (35.2%) or post-operative care (64.8%). Indications for BP control were primarily cardiovascular (55.2%) and neurocritical (39.4%) diagnoses. During clevidipine infusion, patients exceeded their individualized BP target range 5.6% of the time (median; IQR 0.9% – 18.6%). The following factors were significantly associated with poor BP control: prolonged up-titration intervals during active hypertension (p < 0.00001), number of failed weans per hour (defined as when clevidipine was down-titrated and followed within 30 minutes by an interval of persistent hypertension, p < 0.00001), peak infusion doses (p = 0.02), and neurocritical indications (p = 0.03). Conclusions: BP was generally well maintained within the target range, although one quartile of patients experienced hypertension for 18.6% or more of the time. The most impactful factors associated with poor BP control involved clinician management practices such as a longer up-titration interval and failed weans of clevidipine. These findings suggest that substantial ICU hypertension may be preventable with optimal medication up-titration and down-titration during clevidipine administration.
Pepino et al. (Sun,) reported a other. Poor blood pressure control during ICU clevidipine infusion (median 5.6% time above target) was significantly associated with prolonged up-titration intervals and failed weans (p < 0.00001).