New blood-pressure related measure predicts health outcomes in patients with intensive care

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A new method derived from standard blood pressure assessments can improve monitoring of critically ill patients with circulatory shock The method accurately predicts risk of death, length of hospital stay, and blood lactate levels (an indicator of tissue perfusion and oxygenation). BOSTON – Critically ill patients with circulatory shock—when the heart cannot pump enough blood and oxygen to the rest of the body, often as a result of heart failure, sepsis, or hemorrhage—require close monitoring and treatment, especially to maintain adequate blood pressure to prevent injury to important organs. A team led by investigators at Massachusetts General Hospital (MGH) in collaboration with researchers at Massachusetts Institute of Technology (MIT) recently developed a method for monitoring such patients, which may help clinicians control their blood pressure and heart function to reduce the risk of death and other negative health outcomes. The method was tested and validated in a study published in Nature Medicine.

The work involved designing an approach to measure a property of the circulation called the critical closing pressure, which is the blood pressure at which small blood vessels collapse and blood flow stops. Critical closing pressure can provide an indication of blood vessel tone in response to disease and therapy, but it has not been possible to measure this parameter routinely in clinical care.

Development of the new approach utilized high resolution waveform data from blood pressure monitoring of 5,532 patients in the cardiac intensive care unit at MGH. Researchers developed an analysis based on measured parameters (including arterial pressure, pulse pressure, and heart rate) to define the critical closing pressure. They then defined a value called tissue perfusion pressure—calculated as the difference between average arterial blood pressure and critical closing pressure—and found that it predicted a patient’s risk of death, length of hospital stay, and peak blood lactate level (an indicator of tissue oxygenation).

“When treating patients with circulatory shock, it is essential to maintain adequate blood pressure targets, yet standard goals are not personalized to individual patients. We have developed a new metric that can identify individuals with inadequate tissue perfusion who are at risk for adverse outcomes. We believe this method can be used to optimize treatment decisions for patients in the intensive care unit,” says senior author Aaron Aguirre, MD, PhD, an attending cardiologist and critical care specialist at MGH and an assistant professor of Medicine at Harvard Medical School.

Dr. Aguirre’s team will conduct additional studies to understand how tissue perfusion pressure varies with different therapies. They also plan to design clinical trials to test whether their new method can help guide clinical care and improve health outcomes in critically ill patients.

Additional contributors include co-first authors Anand Chandrasekhar and Raimon Padrós-Valls and co-authors Roger Pallarès-López, Eric Palanques-Tost, Nicholas Houstis, Thoralf M. Sundt, Hae-Seung Lee, and Charles G. Sodini.

This work was funded by the Wellman Center at MGH, the National Institutes of Health, and the MIT Center for Integrated Circuits and Systems.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.

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