Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering

Shengjun Liu; Longxiang Su; Xin Liu; Xueqian Zhang; Zuyu Chen; Chun Liu; Na Hong; Yali Li; Yun Long

doi:10.21037/atm-21-2806

Recognizing blood pressure patterns in sedated critically ill patients on mechanical ventilation by spectral clustering

Ann Transl Med. 2021 Sep;9(18):1404. doi: 10.21037/atm-21-2806.

Authors

Shengjun Liu¹, Longxiang Su¹, Xin Liu², Xueqian Zhang², Zuyu Chen², Chun Liu³, Na Hong³, Yali Li², Yun Long¹

Affiliations

¹ Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
² Department of Electronic Engineering, Tsinghua University, Beijing, China.
³ Digital Health China Technologies Co., Ltd., Beijing, China.

Abstract

Background: Blood pressure is a critical therapeutic goal in intensive care unit (ICU). One important factor influencing blood pressure are analgesia and sedation. Analgesic and sedative drugs are commonly used in critically ill patients. These drugs affect blood pressure by reducing the tension of the venous system, the cardiac preload, and cardiac output and inhibiting cardiac functions. Consequently, vasoactive agents are commonly used to increase blood pressure. The indications for the usage of vasoactive agents are unequivocal. However, opinions on when to stop raising blood pressure vary. This study explored the relationship between blood pressure and sedation.

Methods: Patients in the Multiparameter Intelligent Monitoring in Intensive Care-III (MIMIC) database who had received mechanical ventilation, had been administered sedative analgesics during their ICU stay, and met the inclusion criteria were included in this study. The mean arterial pressure (MAP) tendency patterns were identified using spectral clustering and visualized using the t-distributed Stochastic Neighbor Embedding (t-SNE) algorithm. The 28-day mortality rates of patients with different MAP patterns during their first 24 hours in the ICU and their sedation levels were calculated in the crosstab.

Results: Fourteen thousand seven hundred and eighty-five patients from the MIMIC-III database were included in this study. Three MAP patterns were identified by spectral clustering. The median MAP of the low, moderate, and high MAP groups was 71.2, 80.4, and 97.6 mmHg, respectively. The 28-day mortality rate of patients in the moderate MAP group (13.0%) was lower than that of patients in the low (16.6%) and high (15.6%) MAP groups. No difference was found in the 28-day mortality rate between the low and high MAP groups. Dynamic changes in blood pressure at different sedation depths were also examined. Notably, compared with light and moderate sedation level, patients in the deep sedation group, especially those in the high MAP group (48.5%), had a higher 28-day mortality rate (36.5%).

Conclusions: Low MAP in the first 24 hours in ICU indicates a high possibility of poor prognosis for critically ill patients on mechanical ventilation. For patients under deep sedation, maintaining a high mean arterial pressure also indicates poor prognosis. A personalized MAP target should be determined according to the severity of illness and level of sedation for each patient.

Keywords: Blood pressure patterns; mechanical ventilation; sedation administration; spectral clustering; t-distributed stochastic neighbor embedding (t-SNE).