Hypotensive Events and Patient Safety: Why Beat-By-Beat Blood Pressure Matters
Acute hypotensive events (AHE) are among the most severe threats to intraoperative and postoperative patients. Monitoring blood pressure is, therefore, a critical function for patients, not only in the operating room and ICU but also in the postoperative wards.
An AHE is defined as a drop in the mean arterial pressure below 65 mm Hg, lasting five consecutive minutes of more. It can be the sign of a serious problem, such as bleeding, sepsis, adrenal insufficiency, or cardiac issues. Not surprisingly, it is associated with adverse outcomes in critically ill patients, such as stroke, heart attack, and kidney failure.
Early detection of AHEs
Early detection of an AHE is vital. It is one of the first signs of patient deterioration. If allowed to develop, it can result in shock, multi-organ failure and death. This is universally recognized in the intraoperative environment. Numerous studies have shown hypotension during surgery to be associated with postoperative morbidity and early mortality; therefore, AHE monitoring in surgery and in the ICU is a priority for early detection.
However, most of these studies into intraoperative hypotension and its adverse influence on postoperative outcome have not taken account of hypotension during the early postoperative period. As a result, postoperative patients are being left at risk because the monitoring protocols in the postoperative wards are not sufficient to provide the early detection required.
The monitoring gap on the general floor is even greater, as patients are typically only monitored at intervals of four to six hours. These intervals leave ample opportunity for AHEs to occur unnoticed, and develop without treatment, leading ultimately to organ failure. Recent studies have associated postoperative hypotension with myocardial injury and infarction.
Practical Postoperative Monitoring
So why do postoperative patients not receive the same level of hemodynamic supervision as they do in surgery and the ICU? There are essentially two reasons. The first is cost. Healthcare trusts don’t have the budgets to roll out the expensive monitoring equipment used intraoperatively across the postoperative wards.
The second is comfort and convenience. Intraoperative monitoring is invasive and quite cumbersome, connecting patients by wires to monitoring screens. This is practical when patients are under anesthetic but once out on the ward and conscious, the invasive sensors become a cause of discomfort and the wires a hindrance to nursing care.
Wireless beat-by-beat blood pressure monitoring provides a solution to both these obstacles. A Bluetooth enabled, wrist worn device like Caretaker 4 is both comfortable and cost-effective, which means it can be worn by all postoperative patients and provide constant monitoring of vital signals of hypotension: heart rate, pulse oximetry, and arterial blood pressure.
Hypotension and hypertension have been shown to be linked to poor clinical outcomes right through the perioperative patient journey. Studies have also shown that wearable wireless beat-by-beat monitoring devices can reduce the duration of significant postoperative hypotension compared to the standard, intermittent monitoring using the traditional arm cuff. As we understand more about the risk of hypotension to postoperative patients, it becomes clear that intermittent blood pressure monitoring is leaving patients at severe risk. Continuous monitoring using a wearable wireless device, on the other hand, can significantly improve patient
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Caretaker Medical is a Wireless Digital Health company that has developed a continuous ‘beat-by-beat’ Blood Pressure and Vital Signs monitor that eliminates blind spots between traditional intermittent spot-check monitors and untethers patients from mobility-restricting wires and hoses. The FDA-Cleared Caretaker4 wireless monitor utilizes a simple finger cuff and patented Pulse Decomposition Analysis technology to measure uninterrupted blood pressure, hemodynamics, and other parameters for wire-free, “touchless” continuous patient monitoring that maximizes patient comfort and clinical decision-making. For more information, please visit www.CaretakerMedical.net.