Influence of norepinephrine dose on the discrepancy between non-invasive and invasive blood pressure measurements in patients with septic shock
ZHAO Lu
HOU Chaoqun
WANG Guangfu
ZHANG Ru
Abstract：Objective:To explore the differences between non-invasive blood pressure(NIBP)and invasive blood pressure(IBP)measurements in patients with septic shock receiving norepinephrine treatment,and to identify potential dose thresholds,thereby providing evidence for optimizing hemodynamic monitoring and nursing decision-making.Methods:A retrospective analysis of clinical data of septic shock patients admitted to the intensive care unit(ICU)of a tertiary grade A general comprehensive hospital in Jiangsu province from January 1,2021 to December 31,2023 were conducted.Basic patient information and blood pressure monitoring data were collected.Bland-Altman consistency analysis was used for pairwise comparison.Restricted cubic spline(RCS)correlation analysis was performed.Breakpoint regression analysis was used to identify the dose threshold at which norepinephrine affected blood pressure measurement differences.Results:A total of 102 patients were included,and 1 758 pairs of effective blood pressure data were collected.The bias(±SD,95%LOA)of NIBP and IBP in systolic blood pressure,diastolic blood pressure,and mean arterial pressure were 5.44 mmHg(±14.50 mmHg,-22.98-33.86 mmHg),-6.33 mmHg(±8.84 mmHg,-23.66-11.00 mmHg),-2.41 mmHg(±8.91 mmHg,-19.87-15.05 mmHg),respectively.Breakpoint regression analysis showed that the dose thresholds for norepinephrine were 0.04 μg/(kg·min)for systolic blood pressure,0.19 μg/(kg·min)for diastolic blood pressure,and 0.34 μg/(kg·min)for mean arterial pressure.Further verification analysis showed that the absolute NIBP-IBP difference exceeded 10 mmHg in 50.46%of systolic blood pressure,33.56%of diastolic blood pressure,and 23.55%of mean arterial pressure,respectively.For diastolic blood pressure and mean arterial pressure,after reaching the dose inflection point of norepinephrine,the incidence of blood pressure difference greater than 10 mmHg significantly increased,and IBP was mainly greater than NIBP.In diastolic blood pressure,the occurrence rate increased from 30.38%to 32.38%.And this trend was more pronounced in mean arterial pressure,increasing from 14.34%to 27.44%.Once the norepinephrine infusion exceeded the corresponding potential dose thresholds,the prevalence of differences greater than 10 mmHg rose significantly,with IBP consistently higher than NIBP.The rate increased from 30.38%to 32.38%for diastolic pressure and from 14.34%to 27.44%for mean arterial pressure.Conclusions:Norepinephrine dose progressively enlarges the discrepancy between NIBP and IBP in septic-shock patients,especially after exceeding the potential dose thresholds.Therefore,for such patients,NIBP and IBP must not be regarded as interchangeable.It is recommended that clinicians use both blood pressure measurement methods simultaneously,and strengthen the interpretation of blood pressure monitoring results to provide more accurate nursing care for such patients,assist in guiding clinical decision-making,and improve the accuracy of nursing evaluation.
Keywords：septic shocknorepinephrinenon-invasive blood pressureinvasive blood pressurepotential dose thresholdsmonitornursing
Publication Date：2025-12-10
Online Publishing Date：2025-12-08(First online date of this platform, not the publication date of the document)
Pages：9( 3911-3919 )