Xiujuan Wu1, Zongming Jiang2, Jing Ying3, Yangyang Han4, Zhonghua Chen5. 1. Department of Nephrology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China. 2. Department of Anaesthesiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China. 3. Department of Anaesthesiology, Ningbo First Hospital, Ningbo, Zhejiang, China. 4. Department of Anaesthesiology, Ningbo NO.2 Hospital, Ningbo, Zhejiang, China. 5. Department of Anaesthesiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China. Electronic address: zhonghuachen64@163.com.
Abstract
STUDY OBJECTIVE: To determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period. DESIGN: A prospective, randomized study. SETTING:Three teaching hospitals in China. PATIENTS: Six hundred seventy-eight elderly patients with chronic hypertension undergoing major gastrointestinal surgery. INTERVENTIONS: Patients were randomly allocated to three groups and the target MAP level was strictly controlled to one of three levels: level I (65-79mmHg), level II (80-95mmHg), or level III (96-110mmHg). MEASUREMENTS: The primary outcome was acute kidney injury (AKI) (50% or 0.3mg·dL-1increase in creatinine level) during the first 7 postoperative days. The secondary outcomes were perioperative adverse complications. Moreover, vasoactive agents were observed during surgery. MAIN RESULTS: The overall incidence of postoperative AKI was 10.9% (71/648). AKI occurred significantly less often in patients with level II MAP control (6.3%;13/206) than in patients with level I (13.5%; 31/230) and level III (12.9%; 27/210) (P<0.001) MAP control. Level II was associated with lower incidences of hospital-acquired pneumonia (6.7%; 14/206; P=0.014) and admission to the intensive care unit (ICU) (4.4%; 9/206; P=0.015) and with shorter length of stay in the ICU (P=0.025) when compared with level I and level III. Use of norepinephrine, phenylephrine, and nitroglycerin was significantly higher for patients with level III MAP control than for patients with level I and level II MAP control (P=0.001). CONCLUSIONS: For elderly hypertensive patients, controlling intraoperative MAP levels to 80 to 95mmHg can reduce postoperative AKI after major abdominal surgery.
RCT Entities:
STUDY OBJECTIVE: To determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period. DESIGN: A prospective, randomized study. SETTING: Three teaching hospitals in China. PATIENTS: Six hundred seventy-eight elderly patients with chronic hypertension undergoing major gastrointestinal surgery. INTERVENTIONS:Patients were randomly allocated to three groups and the target MAP level was strictly controlled to one of three levels: level I (65-79mmHg), level II (80-95mmHg), or level III (96-110mmHg). MEASUREMENTS: The primary outcome was acute kidney injury (AKI) (50% or 0.3mg·dL-1increase in creatinine level) during the first 7 postoperative days. The secondary outcomes were perioperative adverse complications. Moreover, vasoactive agents were observed during surgery. MAIN RESULTS: The overall incidence of postoperative AKI was 10.9% (71/648). AKI occurred significantly less often in patients with level II MAP control (6.3%;13/206) than in patients with level I (13.5%; 31/230) and level III (12.9%; 27/210) (P<0.001) MAP control. Level II was associated with lower incidences of hospital-acquired pneumonia (6.7%; 14/206; P=0.014) and admission to the intensive care unit (ICU) (4.4%; 9/206; P=0.015) and with shorter length of stay in the ICU (P=0.025) when compared with level I and level III. Use of norepinephrine, phenylephrine, and nitroglycerin was significantly higher for patients with level III MAP control than for patients with level I and level II MAP control (P=0.001). CONCLUSIONS: For elderly hypertensivepatients, controlling intraoperative MAP levels to 80 to 95mmHg can reduce postoperative AKI after major abdominal surgery.
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