Higher versus lower mean arterial pressure target management in older patients having non-cardiothoracic surgery: A prospective randomized controlled trial

Hu, An-Min; Qiu, Yan; Zhang, Peng; Zhao, Rui; Li, Shutao; Zhang, Yaoxian; Zheng, Zihao; Hu, Bailong; Yang, Yali; Zhang, Zhongjun

doi:10.1016/j.jclinane.2020.110150

Cited by 18 publications

(22 citation statements)

References 33 publications

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“…Intriguingly, an intermediate MAP is conducive for postoperative renal function recovery, although the authors assigned the patients to three preset MAP groups arbitrarily, suggesting that strict BP control is beneficial for organ functioning in patients with a normal BP range. Similarly, in a multicenter randomized study, 322 elderly patients were assigned to two groups based on intraoperative MAP levels (60–70 or 90–100 mmHg), and the results concluded that a high MAP significantly reduces the occurrence of postoperative delirium [ 66 ]. In nonsurgical patients, the BP management strategy affects cognitive function, and a good control for hypertension reduces the risk of cognitive impairment.…”

Section: Individualized Hemodynamic Management In Perioperative Care ...mentioning

confidence: 99%

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: Individualized Hemodynamic Management In Perioperative Care ...mentioning

confidence: 99%

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

Song

Jiang

2022

Oxidative Medicine and Cellular Longevity

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“…12,13 Two other trials succeeded in achieving a blood pressure difference of at least 10 mmHg, and two trials did not report the achieved blood pressures (Table 1). [9][10][11]14 All trials were assessed as having an intermediate risk of bias (eTable 2, http://links.lww.com/EJA/A705).…”

Section: Editormentioning

confidence: 99%

“…Five trials reported renal complications. Only Wu et al found increased postoperative creatinine in the hypotensive group 9–12,14 . Three trials reported cardiac complications and found no significant differences between groups 9,12,14 .…”

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confidence: 98%

“…Morrison et al found a decrease in 24-h mortality in the lower target group, but the difference in 30-day mortality was nonsignificant 13 . Four other trials found no difference in mortality 9,11,12,14 . Two trials reported hospital length of stay and found no difference 9,10 .…”

mentioning

confidence: 99%

“…Only Wu et al found increased postoperative creatinine in the hypotensive group 9–12,14 . Three trials reported cardiac complications and found no significant differences between groups 9,12,14 . Four trials reported data on intraoperative bleeding with no differences between groups 9,11–13 …”

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confidence: 99%

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Blood pressure targets during general anaesthesia for noncardiac surgery

Bolther

Henriksen

Holmberg

et al. 2022

European Journal of Anaesthesiology

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Assistance with the article: the authors would like to thank the 'Clinical Skills Development Service' in Brisbane and Clinton Henderson for their contribution in setting up the manikins used for the study, Cambell Smyth for his contribution in the CAD design of the device and the drawings presented in this article, Joanne Zuo for her contribution with the digital data analysis, Jose Medrano for his suggestions for the design of the study, and Sergio Lordao and Michael Minoza for their contribution taking the photos and video.Financial support and sponsorship: none.Conflicts of interest: JMA has created the concept and design of the Airway Shield and has filed an international patent for commercial use. JL and KS have no conflicts of interest to declare.

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Haemodynamic monitoring during noncardiac surgery: past, present, and future

Kouz,

Thiele,

Michard

et al. 2024

J Clin Monit Comput

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During surgery, various haemodynamic variables are monitored and optimised to maintain organ perfusion pressure and oxygen delivery – and to eventually improve outcomes. Important haemodynamic variables that provide an understanding of most pathophysiologic haemodynamic conditions during surgery include heart rate, arterial pressure, central venous pressure, pulse pressure variation/stroke volume variation, stroke volume, and cardiac output. A basic physiologic and pathophysiologic understanding of these haemodynamic variables and the corresponding monitoring methods is essential. We therefore revisit the pathophysiologic rationale for intraoperative monitoring of haemodynamic variables, describe the history, current use, and future technological developments of monitoring methods, and finally briefly summarise the evidence that haemodynamic management can improve patient-centred outcomes.

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Higher versus lower mean arterial pressure target management in older patients having non-cardiothoracic surgery: A prospective randomized controlled trial

Cited by 18 publications

References 33 publications

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

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

Blood pressure targets during general anaesthesia for noncardiac surgery

Haemodynamic monitoring during noncardiac surgery: past, present, and future

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