Frequency, nature and timing of clinical deterioration in the early postoperative period

Iddrisu, Suad Mohammed; Considine, Julie; Hutchinson, Ana

doi:10.1111/jocn.14611

Cited by 13 publications

(10 citation statements)

References 49 publications

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“…Furthermore, longer duration and greater magnitude of hypotension (systolic BP < 90 mmHg) significantly increase the risk of myocardial injury [ 54 ]. Similarly, Mohammed et al [ 85 ] and Kause et al [ 86 ] also observed that systolic BP < 90 mmHg was associated with postoperative emergency events in the general ward. Based on existing literature [ 82 , 87 , 88 ], POH is an independent surrogate predictor for postoperative myocardial injury, and avoiding POH helps to attenuate myocardial injury.…”

Section: Postoperative Bp Managementmentioning

confidence: 84%

Provisional Decision-Making for Perioperative Blood Pressure Management: A Narrative Review

Song

Jiang

2022

Oxidative Medicine and Cellular Longevity

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Blood pressure (BP) is a basic determinant for organ blood flow supply. Insufficient blood supply will cause tissue hypoxia, provoke cellular oxidative stress, and to some extent lead to organ injury. Perioperative BP is labile and dynamic, and intraoperative hypotension is common. It is unclear whether there is a causal relationship between intraoperative hypotension and organ injury. However, hypotension surely compromises perfusion and causes harm to some extent. Because the harm threshold remains unknown, various guidelines for intraoperative BP management have been proposed. With the pending definitions from robust randomized trials, it is reasonable to consider observational analyses suggesting that mean arterial pressures below 65 mmHg sustained for more than 15 minutes are associated with myocardial and renal injury. Advances in machine learning and artificial intelligence may facilitate the management of hemodynamics globally, including fluid administration, rather than BP alone. The previous mounting studies concentrated on associations between BP targets and adverse complications, whereas few studies were concerned about how to treat and multiple factors for decision-making. Hence, in this narrative review, we discussed the way of BP measurement and current knowledge about baseline BP extracting for surgical patients, highlighted the decision-making process for BP management with a view to providing pragmatic guidance for BP treatment in the clinical settings, and evaluated the merits of an automated blood control system in predicting hypotension.

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Section: Postoperative Bp Managementmentioning

confidence: 84%

Provisional Decision-Making for Perioperative Blood Pressure Management: A Narrative Review

Song

Jiang

2022

Oxidative Medicine and Cellular Longevity

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“…The dominance of hypotension and tachycardia as triggers for MET calls is consistent with previous work in orthopaedic surgical cohorts. 18,19 These observations suggest that future research could focus on identifying predictive factors for hypotension and tachycardia after surgery, and subsequently potential therapeutic interventions to reduce the risk of deterioration. Additionally, while knowing the most likely trigger for a MET call is helpful, the deterioration syndrome of postoperative hypotension, for example, can be caused by a number of underlying pathological processes.…”

Section: Discussionmentioning

confidence: 99%

“…17 In surgical patients selected from mixed cohorts, the commonest triggers were hypotension, hypoxia and tachycardia. [18][19][20] Risk factors for MET calls in surgical patients in previous studies included older age, more extensive comorbidity, living with greater degrees of frailty, 21,22 atrial fibrillation, 23 obstructive sleep apnoea (OSA), 24 chronic liver disease, surgical duration, and sedation in PACU. 25 Up to 22% of surgical patients who experience a MET call have more than one activation, 26,27 increasing the risk of mortality compared with a single MET call.…”

Section: Introductionmentioning

confidence: 99%

Triggers for medical emergency team activation after non-cardiac surgery

Douglas

Coleman

Steel

et al. 2023

Anaesth Intensive Care

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Deterioration after major surgery is common, with many patients experiencing a medical emergency team (MET) activation. Understanding the triggers for MET calls may help design interventions to prevent deterioration. We aimed to identify triggers for MET activation in non-cardiac surgical patients. A retrospective cohort study of adult patients who experienced a postoperative MET call at a single tertiary hospital was undertaken. The trigger and timing of each MET call and patient characteristics were collected. Four hundred and one MET calls occurred after 23,258 surgical procedures, a rate of 1.7% of all non-cardiac surgical procedures, accounting for 11.7% of all MET calls over the study period. Hypotension (41.4%) was the most common trigger, followed by tachycardia (18.5%), altered conscious state (11.0%), hypoxia (10.0%), tachypnoea (5.7%), ‘other’ (5.7%), clinical concern (4.0%), increased work of breathing (1.5%) and bradypnoea (0.7%). Cardiac and/or respiratory arrest triggered 1.2% of MET activations. Eighty-six percent of patients had a single MET call, 10.2% had two, 1.8% had three and one patient (0.3%) had four. The median interval between post-anaesthetic care unit (PACU) discharge and MET call was 14.7 h (95% confidence interval 4.2 to 28.9 h). MET calls resulted in intensive care unit (ICU) admission in 40 patients (10%), while 82% remained on the ward, 4% had a MET call shortly after ICU discharge and returned there, 2% returned to theatre, and 2% went to a high dependency unit. Hypotension was the most common trigger for MET calls after non-cardiac surgery. Deterioration frequently occurred within 24 h of PACU discharge. Future research should focus on prevention of hypotension and tachycardia after surgery.

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Section: Introductionmentioning

confidence: 99%

“…The most common trigger for MET calls in postoperative patients is hypotension, [14][15][16][17][18] with the most significant occurrences within the first 24 hr after surgery. 14,16,18 Patients with premorbid physiological derangement are at higher risk of deterioration postoperatively. 19 Management guidelines such as the enhanced recovery after surgery (ERAS) have been implemented to minimize complications, for example minimizing fasting periods and close management of intraoperative and postoperative fluid regimes.…”

Section: Introductionmentioning

confidence: 99%

Nature and characteristics of orthopaedic medical emergency team (MET) events: a retrospective study of 263 MET calls

Kang¹,

Onggo²,

Simpson

et al. 2022

Current Orthopaedic Practice

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Background:Medical emergency teams (MET) are globally recognized strategies to improve outcomes of deteriorating patients. This study aimed to compare characteristics of hypotension and nonhypotension MET calls by characterizing triggers, timings, risk factors, management strategies, and outcomes of postoperative orthopaedic MET calls and provide information in identifying patients who require further perioperative assessment to facilitate better patient care. Methods:A retrospective, single-center review of postoperative orthopaedic MET calls between October 2017 and April 2019 was performed. MET calls were categorized into three groups depending on MET triggers and analyzed by preoperative, intraoperative, and postoperative parameters. Results:Comparing hypotension-only MET events (Group 1) with other triggers (Group 3), Group 1 showed patients who were younger (71.9 yr vs. 75.8 yr, P = 0.012), had elective procedures (52.0% vs. 37.1%, P = 0.032), and had non-neck of femoral fracture (71.0% vs. 53.0%, P = 0.007). They had fewer comorbidities (Charlson Comorbidity Index: 2.7 vs. 3.6, P = 0.011), fewer imaging investigations (12.0% vs. 50.8%, P < 0.05), larger volume fluid boluses (0.36L vs. 0.09L, P < 0.05), and fewer medication changes (27.0% vs. 43.2%, P = 0.013) or additions (18.0% vs. 56.8%, P < 0.05). Conclusions:Older age, emergency surgery, higher Charlson Comorbidity Index, preoperative delirium or dementia, and non-neck of femoral fracture orthopaedic patients were at higher risk of nonhypotension METs. In postoperative orthopaedic patients, hypotension-only METs were managed with an average crystalloid fluid bolus of 0.36L. Nonhypotension METs were more likely to be discharged to high level care nursing homes (HLCNH) and less likely to have an ICU admission. These findings have clinical implications for better patient identification and resource allocation of hospital systems.

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Frequency, nature and timing of clinical deterioration in the early postoperative period

Abstract: Haemodynamic instability leading to the activation of rapid response systems is very common in the immediate postoperative period. There is the need for locally tailored interventions to optimise fluid management and decrease incidence of further complications.

Cited by 13 publications

References 49 publications

Provisional Decision-Making for Perioperative Blood Pressure Management: A Narrative Review

Provisional Decision-Making for Perioperative Blood Pressure Management: A Narrative Review

Triggers for medical emergency team activation after non-cardiac surgery

Nature and characteristics of orthopaedic medical emergency team (MET) events: a retrospective study of 263 MET calls

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