Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis

Abstract

Purpose The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes. Methods CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses. Results A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of ‘no hypotension’ for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12–1.88; based on 13 studies and 34,829 patients), but not for AKI. Conclusion Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07304-4.

Performance of a Machine Learning Algorithm to Predict Hypotension in Spontaneously Breathing Non-Ventilated Post-Anesthesia and ICU Patients

“…Notably, hypotension in the first four days after surgery was significantly associated with a composite outcome of myocardial infarction and death, independently of preceding intraoperative hypotension [6]. Additionally, hypotension is a well-established risk factor for adverse outcomes, such as mortality and acute kidney injury, in the ICU [7]. In this study, patients spent 10.4% of the total monitoring time in hypotension, a substantial percentage for a patient population that may exhibit other warning signs of hypotension.…”

“…Hypotension is common in the intensive care unit (ICU) [1], intra-operative [2] and post-operative environments [3,4]. The prevention of hypotension in all three environments may reduce the incidence of major adverse events, such as acute kidney injury (AKI), myocardial injury and death [5][6][7]. To facilitate a more proactive and timely treatment of hypotension, clinicians may benefit from incorporating machine learning and other advanced predictive algorithms into their decision-making process.…”

The impact of pre-rehydration guided by carotid corrected flow time on hypotension prevention following general anesthesia induction in patients undergoing gastrointestinal surgery: a prospective randomized controlled trial

“…Patients with gastrointestinal tumors are more susceptible to insufficient blood volume and subsequent post-induction hypotension due to the disease itself and prolonged intestinal preparation (2). Intraoperative hypotension is associated with The incidence of hypotension after general anesthesia induction between Group C and Group F. delayed awakening, acute kidney injury, myocardial ischemia, and increased perioperative mortality (17,18). Therefore, accurately assessing a patient's volume status and implementing appropriate therapeutic measures are crucial.…”