ArticleBMJ open2012
Interrogating a clinical database to study treatment of hypotension in the critically ill.
Article in BMJ open, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 16 citations in OpenAlex.
- Relative sparsity for medical decision problems.Statistics in medicine · 2023Article
- Domain Adaptation Using Convolutional Autoencoder and Gradient Boosting for Adverse Events Prediction in the Intensive Care Unit.Frontiers in artificial intelligence · 2022Article
- Variable selection and estimation in causal inference using Bayesian spike and slab priors.Statistical methods in medical research · 2020Article
- -Omic and Electronic Health Record Big Data Analytics for Precision Medicine.IEEE transactions on bio-medical engineering · 2017Review
- The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study.Journal of critical care · 2016Article
- Donor preoperative oxygen delivery and post-extubation hypoxia impact donation after circulatory death hypoxic cholangiopathy.World journal of gastroenterology · 2016Article
- Dynamic clinical data mining: search engine-based decision support.JMIR medical informatics · 2014Article
- "Big data" in the intensive care unit. Closing the data loop.American journal of respiratory and critical care medicine · 2013Article
- Dynamic data during hypotensive episode improves mortality predictions among patients with sepsis and hypotension.Critical care medicine · 2013Article
- Using existing data to address important clinical questions in critical care.Critical care medicine · 2013Review
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveIn intensive care, it is imperative to resolve hypotensive episodes (HEs) in a timely manner to minimise end-organ damage. Clinical practice guidelines generally recommend initial treatment with fluid resuscitation followed by vasoactive agent administration if patients remain hypotensive. However, the impact of such interventions on patient outcomes has not been clearly established. Hence, the objective of this study was to investigate the relationship between fluid and vasoactive agent interventions and patient outcomes, while highlighting the utility of electronic medical records in clinical research.
designRetrospective cohort study.
settingIntensive care units (ICUs) at a large, academic, tertiary medical center.
participantsPatients in Multi-parameter Intelligent Monitoring in Intensive Care II (a large electronic ICU database) who experienced a single HE during their ICU stay. 2332 patients had complete data. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome of interest was inhospital mortality. Secondary outcomes were ICU length of stay (LOS), HE duration, Hypotension Severity Index (defined as the mean arterial pressure curve area below 60 mm Hg during the HE) and rise in serum creatinine.
resultsFluid resuscitation was associated with significantly shorter ICU LOS among ICU survivors (p=0.007). Vasoactive agent administration significantly decreased HE duration (p<0.001) and Hypotension Severity Index (p=0.002) but was associated with increased inhospital mortality risk (p<0.001), prolonged ICU LOS among ICU survivors (p=0.04) and rise in serum creatinine (p=0.002) after adjustment for confounders. Propensity score analyses as well as sensitivity analyses in treatment-, diagnosis- and ICU service-specific subpopulations corroborated the relationship between vasoactive agents and increased inhospital mortality.
conclusionsAn adverse relationship between vasoactive agents and inhospital mortality was found in patients with hypotension. This study has implications for the care of critically ill patients with hypotension and illustrates the utility of electronic medical records in research when randomised controlled trials are difficult to conduct.
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Registered trials
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