The Futility of Orthostatic Measurements
Are you still doing orthostatic measurements (i.e. lying and standing blood pressures or heart rate changes) for assessing volume status and acute volume loss?
Maybe you’ll stop after hearing Anand (@EMSwami) Swaminathan’s investigation into the (lack of) evidence for this widely accepted pseudoaxiomatic urban legend
Assess for orthostatic symptoms, not blood pressure changes.
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
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It seems somewhat contradictory to say that baseline orthostatic changes are present in 44-50% of healthy volunteers, but that their sensitivity in moderate blood loss is only 22% for HR/BP changes. Does this not imply that the frequency of observed changes nearly halved after blood donation? These results seem highly counter-intuitive, and I would think raise a reason to be sceptical about the reproducibility of the findings.
I’d never heard of using orthostatic BP for assessing fluid status. I thought it was to assess for autonomic dysfunction.