Continuing Medical Education Article
Analysis of the evidence for the lower limit of systolic and mean
arterial pressure in children
Ikram U. Haque, MD, FAAP; Arno L. Zaritsky, MD, FAAP, FCCM
LEARNING OBJECTIVES
On completion of this article, the reader should be able to:
1. Identify key factors that contribute to determining the optimal blood pressure goals for resuscitation of critically ill children.
2. Select appropriate blood pressure targets in critically ill children.
3. Recall the relationship between systolic, diastolic, and mean arterial blood pressure.
Both authors have disclosed that they have no financial relationships with or interests in any commercial companies
pertaining to this educational activity.
Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity.
Visit the Pediatric Critical Care Medicine Web site (www.pccmjournal.org) for information on obtaining continuing medical
education credit.
Objective: Systolic blood pressure (SBP) and mean arterial pressure (MAP) are essential evaluation elements in ill children, but there
is wide variation among different sources defining systolic hypotension in children, and there are no normal reference values for MAP.
Our goal was to calculate the 5th percentile SBP and MAP values in
children from recently updated data published by the task force
working group of the National High Blood Pressure Education Program and compare these values with the lowest limit of acceptable
SBP and MAP defined by different sources.
Design: Mathematical analysis of clinical database.
Methods: The 50th and 95th percentile SBP values from task
force data were used to derive the 5th percentile value for children
from 1 to 17 yrs of age stratified by height percentiles. MAP values
were calculated using a standard mathematical formula. Calculated
SBP values were compared with systolic hypotension definitions
from other sources. Linear regression analysis was applied to create
simple formulas to estimate 5th percentile SBP and 5th and 50th
percentile MAP for different age groups at the 50th height percentile.
Results: A 9 –21% range in both SBP and MAP values was
noted for different height percentiles in the same age groups. The
5th percentile SBP values used to define hypotension by different
sources are higher than our calculated values in children but are
M
lower than our calculated values in adolescents. Clinical formulas
for calculation of SBP and MAP (mm Hg) in normal children are as
follows: SBP (5th percentile at 50th height percentile) ⴝ 2 ⴛ age
in years ⴙ 65, MAP (5th percentile at 50th height percentile) ⴝ
1.5 ⴛ age in years ⴙ 40, and MAP (50th percentile at 50th height
percentile) ⴝ 1.5 ⴛ age in years ⴙ 55.
Conclusion: We developed new estimates for values of 5th
percentile SBP and created a table of normal MAP values for
reference. SBP is significantly affected by height, which has not
been considered previously. Although the estimated lower limits
of SBP are lower than currently used to define hypotension, these
values are derived from normal healthy children and are likely not
appropriate for critically ill children. Our data suggest that the
current values for hypotension are not evidence-based and may
need to be adjusted for patient height and, most important, for
clinical condition. Specifically, we suggest that the definition of
hypotension derived from normal children should not be used to
define the SBP goal; a higher target SBP is likely appropriate in
many critically ill and injured children. Further studies are needed
to evaluate the appropriate threshold values of SBP for determining hypotension. (Pediatr Crit Care Med 2007; 8:138 –144)
KEY WORDS: blood pressure; hypotension; infant; child
onitoring blood pressure in
critically ill or injured children is considered one of
the mainstays for patient
evaluation in the prehospital setting, pe-
diatric emergency department, and intensive care unit (1–5). Studies in adults
and children with trauma showed that
systolic blood pressure (SBP) is a predictor of mortality (6) and that prehospital
Assistant Professor (IUH), Professor and Chief
(ALZ), Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Florida College of
Medicine, Gainesville, FL.
Copyright © 2007 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
138
DOI: 10.1097/01.PCC.0000257039.32593.DC
hypotension is associated with an increased risk of mortality (7–10). The
depth and duration of hypotension appear
to have a direct relationship with adverse
hospital outcome in emergency department patients with nontraumatic shock
(11). Moreover, hypotension is used as a
criterion for diagnosis of “decompensated” shock along with other features of
poor perfusion in pediatric patients (1, 3).
Most published guidelines define hypoPediatr Crit Care Med 2007 Vol. 8, No. 2
tension in children as an SBP below the
5th percentile for age. Table 1 is a summary of SBP values as used by the Pediatric Advanced Life Support (PALS)
course, Brain Trauma Foundation (BTF),
and International Pediatric Sepsis Consensus Conference to define hypotension
in children. These guidelines for hypotension are reportedly derived from the
reports of the task force on blood pressure control in normal healthy children
(12, 13). Although age-related “norms” of
blood pressure are published in most of
the relevant pediatric emergency and
critical care training manuals and textbooks, the evidence for these norms is
usually not referenced and the publications do not report the confidence intervals for normal blood pressure or adjustments of these norms for gender or for
height and weight of the child within an
age group. Variation in the age-based
range of blood pressure was observed in
the recently published international consensus conference definitions of sepsis
and organ dysfunction in children, which
included a table of the lower limits of
acceptable SBP (14). These guidelines reportedly were based on a review of published studies but appear to overestimate
the lower limits of SBP in different aged
children, as shown in Table 1.
Hemodynamic treatment of shock is
aimed at maintaining oxygen delivery
above a critical threshold and increasing
mean arterial pressure (MAP) to a level
that allows appropriate distribution of
cardiac output for adequate tissue perfusion (15). In adults, a MAP range from 60
to 90 mm Hg has been used as the desired
target (16 –19) for therapeutic end points
such as improved urine output and creatinine clearance (20). In children, several sources recommend early aggressive
restoration of hemodynamic end points,
which include normalization of MAP to
age-appropriate values in pediatric shock
states (1, 3, 21–23). Unfortunately, there is
little objective evidence defining the target
values of MAP in pediatric patients. Furthermore, no age-related MAP nomogram
in children is available for clinicians to use
as a reference. Neonatal studies have collected data on the normal values of blood
pressure in very low birth weight infants
(24 –26), but there are no pediatric studies
of MAP from children in the pediatric intensive care unit. When mathematical integration of invasive arterial pressure measurements to calculate the MAP is not
available, MAP is typically calculated by using the following formula, which assumes
that one third of the cardiac cycle is spent
in systole (27–29):
MAP ⫽ diastolic pressure
⫹ ([systolic pressure
⫺ diastolic pressure]/3)
[1]
The aim of this study was to use a
large published database of blood pressures in children to estimate the lower
limits of systolic pressure and define normal mean arterial pressures using the
preceding equation and to compare these
estimates with those that are currently
being used. To achieve our aim, we used
data from the working group of the National High Blood Pressure Education
Programs, which recently published updated guidelines on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents (30). We
analyzed the data from this report using
standard mathematical models to calculate the 5th percentile values of SBP and
diastolic blood pressure for the entire pediatric population.
Table 1. Definition of hypotension in children by different sources
Hypotension Guidelines, mm Hg
Age Group
0 days–1 wk
1 week–1 mo
1 mo–1 yr
⬎1–5 yrs
6–12 yrs
13–18 yrs
Pediatric Advanced Life
Support
Brain Trauma
Foundationa
International Pediatric Sepsis
Consensus Conferenceb
⬍60
⬍60
⬍70
70 ⫹ 2 ⫻ yrs
70 ⫹ 2 ⫻ yrs (up to 10 yrs)
⬍90 (⬎10 yrs)
⬍90
⬍65
⬍65
⬍65
⬍70–75
⬍80–90
⬍59
⬍79
⬍75
⬍74
⬍83
⬍90
⬍90
a
Brain Trauma Foundation last accessed October 14, 2005 (http://www2.braintrauma.org/
guidelines/downloads/btf_guidelines_prehospital.pdf); b corrected values, letter to the editor, Goldstein et al. Pediatr Crit Care Med 2005; 6:500 –501.
Pediatr Crit Care Med 2007 Vol. 8, No. 2
MATERIALS AND METHODS
The updated blood pressure report is based
largely on data collected by the National Center for Health Statistics with ⬎32,000 boys
and ⬎31,000 girls including new data from
the 1999 –2000 National Health and Nutrition
Examination Survey. The blood pressures reported by the task force were obtained by
auscultatory method in normal healthy children. The revised blood pressure tables now
include the 50th, 90th, 95th, and 99th percentiles by gender, age, and height. The values for
50th percentile and 95th percentile of SBP and
diastolic blood pressure were extracted from
the task force data for all age groups across the
range of height percentiles into tables for both
boys and girls (30). We used simple mathematical calculations to derive the 5th percentile
values of SBP from these data, assuming that
the data in this large database are normally
distributed so that the difference in pressure
between the 95th and 50th percentile should
be the same as the difference between the 5th
percentile and 50th percentile. Tables for values of the 5th percentile SBP for different
ages, genders, and height percentiles were
generated. We then compared calculated values of SBP with currently used guidelines for
defining hypotension from different sources.
The published data and our calculated values of SBP and diastolic pressure at various
percentiles of height for a given age were then
used to estimate the MAPs for age, gender, and
height percentile using the previously stated
formula. We then used linear regression to
determine the line of best fit and from that
regression created simple mathematical formulas for clinicians to approximate values of
the 5th percentile SBP and 5th and 50th percentile for MAP at the 50th height percentile
for children 1–17 yrs of age. We also calculated
the effect of height on the range of SBP values
and derived simple estimates to adjust the SBP
according to the height percentile.
RESULTS
The demographic information on the
source of blood pressure data of the population was described in detail in the
original report (30). Table 2 shows the 5th
percentile values of SBP from age 1–18
yrs for males and females; the table also
details the range of SBP for each age
group ranging from the 5th percentile to
95th percentile for height. As seen in this
table, the SBP in the same age group
varies by approximately 8 –9 mm Hg between the 5th and 95th height percentile
in males and by approximately 6 –7 mm
Hg in females. Relative to the mean SBP,
the magnitude of the difference between
the 5th and 95th height percentile com139
Table 2. Calculated 5th percentile systolic blood pressure (mm Hg) according to height percentiles
among boys (M) and girls (F) 1–18 yrs old
Fifth Percentile Systolic Blood Pressure, Percentile for Height
5th
25th
50th
75th
95th
Age, Yrs
M
F
M
F
M
F
M
F
M
F
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
62
67
68
70
72
73
74
77
77
79
81
83
87
88
92
93
97
66
68
68
71
71
74
76
78
78
80
82
85
87
89
90
91
91
65
70
71
73
76
76
77
80
80
83
85
86
88
91
95
96
98
68
70
71
73
74
76
78
78
81
83
85
87
89
89
92
93
93
67
70
73
75
78
78
79
82
82
85
87
89
90
94
95
98
100
68
71
71
74
76
77
79
81
83
85
85
87
90
92
93
93
93
70
72
76
78
78
81
81
82
85
85
87
91
92
96
97
101
102
71
71
74
74
77
79
79
82
84
86
88
90
92
93
93
96
96
72
74
77
79
80
83
83
84
87
89
89
93
94
98
99
103
104
73
73
76
76
79
81
82
84
86
88
90
92
92
95
95
98
98
pared with the 50th height percentile
SBP by age was 7–14.9% in boys and
5.4 –11.1% in females. This variation is
seen graphically in Figure 1.
The calculated values for MAP at the
5th, 50th, and 95th percentiles stratified
by different height percentiles in the
same age group are shown in Table 3. A
difference of approximately 5– 6 mm Hg
is noted between 5th and 95th height
percentiles for the same age group in
both males and females. This results in a
range of MAP across different heights of
8 –13% in girls and 9 –21% in boys. There
is wide variation, however, in the normal
MAP values across the 5th and 95th percentiles for a given height.
Linear regression was applied to the
50th height percentile group for the 5th
and 50th percentile values of SBP and the
5th and 50th percentile MAP (data not
shown). Simplified formulas for estimating the 5th percentile SBP and the 5th
and 50th percentile MAP for 50th percentile of height were derived from these
values, as shown next. A simple calculation can be used to estimate 5th percentile SBP adjusted for height percentile for
each quartile above or below 50th height
percentile. Our calculations suggest that
for males ⫾2 mm Hg for each height
quartile and for females ⫾1.5 mm Hg for
each quartile of height can approximate
the 25th to 75th percentile SBP values.
The line of best fit for MAP was exponential, but the linear equations produce estimates that are within the range of values across the range of height percentiles
140
and were chosen because they are easier
to recall.
SBP (5th percentile at 50th height
percentile) ⫽ 2 ⫻ age in years ⫹ 65
[2]
SBP (50th percentile at 50th height
percentile) ⫽ 2 ⫻ age in years ⫹ 85
[3]
MAP (5th percentile at 50th height
percentile) ⫽ 1.5 ⫻ age in years
⫹ 40
[4]
MAP (50th percentile at 50th height
percentile) ⫽ 1.5 ⫻ age in years
⫹ 55
[5]
The 5th percentile SBPs are plotted as
shown in Figure 1 for both males and
females along with the PALS, Brain
Trauma Foundation, and International
Pediatric Sepsis Consensus Conference
definitions and our estimated formulas
for SBP determined from regression analysis. The graph shows that systolic blood
pressure limits defined by both PALS and
Brain Trauma Foundation are high compared with our calculated values, and the
PALS limit often exceeds the 5th percentile SBP even in children at the 95th
percentile of height. Moreover, the graph
illustrates that most normal healthy ad-
olescents exceed the 90 mm Hg threshold
for lower limit of acceptable blood pressure recommended in the PALS and Advanced Cardiac Life Support courses for
adolescents.
DISCUSSION
The early detection and rapid treatment of hypotension are important in
the management of critically ill and injured children. Moreover, MAP is often
used as a therapeutic end point in shock
management. Thus, it is important to
define the normal ranges for both variables in children. These normal values
represent a starting point for thinking
about the desired blood pressure target,
but the desired target blood pressure in
a critically ill or injured child is likely
higher than these lower limits of normal blood pressure obtained in healthy
children.
Although not evidence based, hypotension is typically defined as an SBP
less than the 5th percentile for age.
Since it is often difficult to recall blood
pressure data listed in tables by age,
various formulas have been used to estimate the lower limit of acceptable
blood pressure. For example, the formula used in PALS training materials
(1) states that the lower limit of acceptable SBP is 70 ⫹ 2 ⫻ (age in years) for
children from 1 to 10 yrs of age. For
children ⬍1 yr, the lowest acceptable
SBP is 60 mm Hg up to 1 month and 70
mm Hg from 1 month to 1 yr. For
children ⬎10 yrs of age, the lowest acceptable SBP is 90 mm Hg; the latter is
consistent with Advanced Cardiac Life
Support guidelines for defining hypotension in adults (31). A review of different sources revealed substantial variation in their definition of systolic
hypotension, and current sources do
not consider the variation in blood
pressure due to height differences
within an age group. Analysis of our
derived data from the updated blood
pressure data from the task force report
does not agree with any of the recommended threshold blood pressures to define hypotension, making it difficult for the
clinician to know which source to use and
remember. Furthermore, it is interesting
to note that the threshold blood pressure
values used in the Paediatric Logistic Organ Dysfunction score are much higher
than any of the current threshold blood
pressure values that define hypotension
Pediatr Crit Care Med 2007 Vol. 8, No. 2
Figure 1. Fifth percentile systolic blood pressure (BP) according to height (HT) percentiles plotted against Pediatric Advanced Life Support (PALS), Brain
Trauma Foundation (Brain Trauma), and International Pediatric Sepsis Consensus Conference (Int Ped Sepsis) hypotension guidelines, and our new
estimates based on linear regression R2 for boys ⫽ .99 (top) and for girls ⫽ .98 (bottom). Gray lines and the shaded area indicate the calculated values.
Pediatr Crit Care Med 2007 Vol. 8, No. 2
141
Table 3. Calculated mean arterial blood pressure (mm Hg) according to height percentiles among boys (M) and girls (F) 1–18 yrs old
Mean Arterial Blood Pressure for Boys and Girls, Percentile for Height
Age, Yrs
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Percentile
for Blood
Pressure
M
F
M
F
M
F
M
F
M
F
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
5
50
95
30
49
69
35
54
73
39
58
77
42
61
79
45
63
82
47
66
84
51
67
83
50
69
87
51
70
88
52
71
90
54
72
91
54
73
92
56
75
93
59
75
91
58
77
96
60
79
98
63
81
100
35
53
71
39
57
75
42
60
78
45
63
80
46
64
82
49
66
84
50
68
85
52
70
87
53
71
89
54
72
90
55
73
91
57
75
92
58
76
94
60
77
95
61
78
96
61
79
96
61
79
96
33
52
70
38
56
75
41
60
78
43
63
82
47
66
84
49
67
86
50
69
88
53
71
89
53
72
91
55
73
92
56
74
92
57
75
94
57
76
95
59
78
96
61
79
98
62
81
99
63
83
102
37
54
72
41
58
76
44
61
79
46
64
82
48
66
83
50
68
85
51
69
87
52
70
88
54
71
89
55
73
90
56
74
92
58
75
93
59
77
94
60
78
96
61
79
97
62
80
98
62
80
98
34
53
72
39
57
76
42
61
80
46
64
83
49
67
85
50
69
87
52
70
89
54
72
91
55
73
92
56
75
93
57
75
94
58
77
95
59
77
96
61
79
97
62
80
99
63
82
101
65
84
103
37
55
73
42
59
77
44
62
80
47
65
83
49
67
85
51
69
86
52
70
88
54
71
89
55
73
90
56
74
92
57
75
93
58
76
94
60
78
95
61
79
97
62
80
98
63
81
99
63
81
99
36
54
73
40
59
77
44
62
81
47
66
84
49
68
87
52
70
88
53
72
90
55
73
92
56
75
93
56
75
94
58
76
95
60
78
96
60
79
97
62
80
99
63
82
100
65
83
102
67
85
104
39
57
74
42
60
78
46
64
81
47
65
84
50
68
86
52
69
87
53
71
89
55
72
90
56
74
91
57
75
93
59
76
94
60
78
95
61
79
97
62
80
98
63
81
99
63
82
100
65
82
100
37
56
74
41
60
79
45
64
82
48
67
86
51
69
88
53
71
90
54
73
92
56
75
93
58
76
94
59
77
96
59
78
96
61
79
98
61
80
99
63
82
100
64
83
102
66
85
104
69
87
106
40
58
76
44
62
80
47
65
83
49
67
85
52
69
87
54
71
89
55
72
90
56
74
91
57
75
93
59
76
94
60
78
95
61
79
97
62
80
98
64
81
99
64
82
100
66
84
101
66
84
101
5th
(32). These empirically derived blood pressure values suggest that our current
thresholds are too low.
Our study analyzed a large database of
blood pressures in children to provide
objective evidence for the lowest acceptable SBP and MAP. Our data show that
the definition of the 5th percentile SBP
from all the currently used sources is
often higher than the values calculated
based on the largest available database of
142
25th
50th
75th
blood pressure in children. Using a regression model, we developed new simple
formulas that give a more accurate approximation of 5th percentile SBP for different age groups in normal children
from 1 to 17 yrs of age:
SBP (5th percentile at 50th height
percentile) ⫽ 2 ⫻ age in years ⫹ 65
[6]
95th
It is important for clinicians to know
that there is a fairly large difference on a
percentile basis between the lower limit
of SBP for a short vs. a tall child. This
variation has not previously been reported
or used to adjust the goal for assessment or
blood pressure target. We do not know the
clinical or pathophysiologic significance of
this observation. The estimated SBP for
25th and 75th percentile height children at
a given age can be estimated by adding or
Pediatr Crit Care Med 2007 Vol. 8, No. 2
subtracting 2 mm Hg for boys and 1.5 mm
Hg for girls from the SBP estimate at the
50th percentile of height.
Another important finding was that although the adult Advanced Cardiac Life
Support guideline for hypotension uses 90
mm Hg beyond 12 yrs of age, the 5th percentile values for SBP in normal children
in this age group were ⬎90 mm Hg. The
clinical implication of this is not clear except that it suggests that clinicians may be
accepting a lower SBP than appropriate.
Moreover, using the lower limit of SBP as
the definition of decompensated shock and
hypotension and especially as the target for
resuscitation may not be appropriate since
these definitions are based on data in normal children and do not account for the
stress response that occurs in seriously ill
or injured children. For example, in a recent study, Dark et al. (33) followed a cohort of children admitted to the emergency
department with blunt trauma and found
that these patients presented with relative
systolic hypertension compared with ageappropriate SBP as estimated by the guidelines. They speculated that apparently normal blood pressure in children with blunt
trauma could represent relative hypotension. Another study evaluated the relationship between blood pressures and outcome
after severe traumatic brain injury in pediatric patients (34). Poor outcome was associated with an SBP less than the ageadjusted 75th percentile even if the SBP
was ⱖ90 mm Hg. White et al. (35) reported
that the odds of survival increased 19-fold
in pediatric severe traumatic brain injury
patients with maximum SBP of ⬎135 mm
Hg, also suggesting that supranormal
blood pressures are associated with improved outcome in this patient population.
These studies highlight that a higher SBP
target may be particularly important in
children with traumatic brain injury in
whom cerebral perfusion is determined, in
part, by maintenance of an adequate perfusion pressure when intracranial pressure is
increased. It is noteworthy, however, that
the Brain Trauma Foundation still uses an
SBP ⬍90 mm Hg to define hypotension in
adolescents even though a much higher
SBP is needed to maintain cerebral perfusion pressure ⬎70 mm Hg if one assumes
that intracranial pressure is 20 mm Hg.
Since one of the major determinants
of tissue perfusion pressure is MAP, it is
typically used in shock states to estimate
tissue perfusion pressure and thus blood
flow. For example, cerebral perfusion
pressure (CPP) is calculated by the following formula (36):
Pediatr Crit Care Med 2007 Vol. 8, No. 2
CPP ⫽ mean arterial pressure
⫺ intracranial pressure
[7]
Hence, it is important for clinicians
caring for critically ill children to know
whether a child’s MAP is appropriate for
his or her age. We calculated the values of
MAP tabulated according to height percentile for different age groups. The optimal MAP to achieve adequate tissue perfusion pressure in shock is unknown and
likely varies according to the type of
shock. As noted, a higher MAP is likely
needed in children with increased intracranial pressure. Conversely, in a child
with cardiogenic shock treated with vasodilators, adequate tissue perfusion and
improved myocardial performance may
be achieved at a low MAP by maximizing
vasodilator therapy since blood flow is
proportional to MAP ⫼ systemic vascular
resistance. As a starting estimate of adequate perfusion pressure, it may be appropriate to choose the 50th percentile
MAP for age and height as a target based
on the preceding observations that critically ill children often have elevated
blood pressures. Using regression analysis, we created a formula that approximates the MAP for age in both males and
females:
MAP (5th percentile at 50th height
percentile) ⫽ 1.5 ⫻ age in years
⫹ 40
[8]
MAP (50th percentile at 50th height
percentile) ⫽ 1.5 ⫻ age in years
⫹ 55
[9]
Clinicians should recall that MAP values vary across the height percentile
within the same age group, and this variation may need to be considered when
caring for a very short or tall child.
CONCLUSIONS
We developed new estimates of the
fifth percentile SBP for children 1–17 yrs
of age from analysis of recently published
blood pressure data from the Task Force
on Hypertension. Most of the current
guidelines use higher values for defining
hypotension compared with our estimate
from a large pediatric blood pressure database. Since the “normal” blood pressures are obtained from healthy children
at rest, it is rational to use a higher
threshold for defining hypotension in
critically ill children than currently used.
Furthermore, since there is a 5–15%
variation in normal SBP from the 5th to
95th percentile height, the clinician may
need to consider using a length-based
system for determining the appropriate
blood pressure target. Moreover, the clinician should recognize that automated
blood pressure devices are not reliable
when distal pulses are weak to absent,
and other signs of poor perfusion should
be used to define severe shock besides
just a low SBP.
Clearly, there is a critical need for
studies to validate the appropriate blood
pressure target and to better define hypotension in critically ill children. To avoid
confusion among pediatric healthcare
providers, we recommend using a consistent definition of hypotension by all professional groups developing guidelines
for children. This consistent definition of
hypotension, however, should not represent the target blood pressure goal. Instead, we recommend that the target
blood pressure goal should be individually developed based on adequacy of organ perfusion measured by markers of
tissue perfusion such as lactate and urine
output and considering the etiology of
the shock state. For example, epidemiologic studies in trauma patients suggest
that a higher blood pressure target is
appropriate, but this has not been tested
prospectively. We also calculated normal
values for MAP to be used as reference
values while treating critically ill children. Further research is needed to identify appropriate SBP and MAP treatment
goals in populations of critically ill and
injured children, such as children with
traumatic brain injury, to better determine the optimal therapeutic end point.
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