Alparslan Turan1, Christine Chang, Barak Cohen, Wael Saasouh, Hani Essber, Dongsheng Yang, Chao Ma, Karen Hovsepyan, Ashish K Khanna, Joseph Vitale, Ami Shah, Kurt Ruetzler, Kamal Maheshwari, Daniel I Sessler. 1. From the Departments of Outcomes Research (A.T., C.C., B.C., W.S., H.E., K.H., A.K.K., J.V., K.R., K.M., D.I.S.) General Anesthesia (A.T., A.K.K., A.S., K.R., K.M.) the Center for Critical Care (A.K.K.) Anesthesiology Institute, and the Department of Quantitative Health Sciences (D.Y., C.M.), Cleveland Clinic, Cleveland, Ohio the Division of Anesthesia, Critical Care and Pain Management, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (B.C.) the Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan (W.S.).
Abstract
BACKGROUND:Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality. Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured only every 4 to 6 h, leaving long intervals during which hypotension and hypertension may be undetected. This study evaluated the incidence and severity of postoperative hypotension and hypertension in adults recovering from abdominal surgery and the extent to which serious perturbations were missed by routine vital-sign assessments. METHODS:Blood pressure was recorded at 1-min intervals during the initial 48 h in adults recovering from abdominal surgery using a continuous noninvasive monitor. Caregivers were blinded to these measurements and depended on routine vital-sign assessments. Hypotension and hypertension were characterized as time under and above various mean arterial pressure thresholds. RESULTS: Of 502 available patients, 312 patients with high-quality records were analyzed, with a median measurement time of 48 [interquartile range: 41, 48] postoperative hours. Nearly a quarter experienced an episode of mean arterial pressure of less than 70 mm Hg lasting at least 30 min (24%; 95% CI, 20%, 29%), and 18% had an episode of mean arterial pressure of less than 65 mm Hg lasting at least 15 min. Nearly half the patients who had mean arterial pressure of less than 65 mm Hg for at least 15 min (47%; 95% CI, 34%, 61%) were undetected by routine vital-sign assessments. Episodes of mean arterial pressure greater than 110 mm Hg lasting at least 30 min were observed in 42% (95% CI, 37%, 48%) of patients; 7% had mean arterial pressure greater than 130 mm Hg for at least 30 min, 96% of which were missed by routine assessments. Episodes of mean arterial pressure less than 65 mm Hg and mean arterial pressure greater than 110 mm Hg captured by routine vital-sign assessments but not by continuous monitoring occurred in 34 and 8 patients, respectively. CONCLUSIONS:Postoperative hypotension and hypertension were common, prolonged, profound, and largely undetected by routine vital-sign assessments in a cohort of adults recovering from abdominal surgery. Frequent or continuous blood pressure monitoring may detect hemodynamic perturbations more effectively and potentially facilitate treatment.
RCT Entities:
BACKGROUND: Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality. Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured only every 4 to 6 h, leaving long intervals during which hypotension and hypertension may be undetected. This study evaluated the incidence and severity of postoperative hypotension and hypertension in adults recovering from abdominal surgery and the extent to which serious perturbations were missed by routine vital-sign assessments. METHODS: Blood pressure was recorded at 1-min intervals during the initial 48 h in adults recovering from abdominal surgery using a continuous noninvasive monitor. Caregivers were blinded to these measurements and depended on routine vital-sign assessments. Hypotension and hypertension were characterized as time under and above various mean arterial pressure thresholds. RESULTS: Of 502 available patients, 312 patients with high-quality records were analyzed, with a median measurement time of 48 [interquartile range: 41, 48] postoperative hours. Nearly a quarter experienced an episode of mean arterial pressure of less than 70 mm Hg lasting at least 30 min (24%; 95% CI, 20%, 29%), and 18% had an episode of mean arterial pressure of less than 65 mm Hg lasting at least 15 min. Nearly half the patients who had mean arterial pressure of less than 65 mm Hg for at least 15 min (47%; 95% CI, 34%, 61%) were undetected by routine vital-sign assessments. Episodes of mean arterial pressure greater than 110 mm Hg lasting at least 30 min were observed in 42% (95% CI, 37%, 48%) of patients; 7% had mean arterial pressure greater than 130 mm Hg for at least 30 min, 96% of which were missed by routine assessments. Episodes of mean arterial pressure less than 65 mm Hg and mean arterial pressure greater than 110 mm Hg captured by routine vital-sign assessments but not by continuous monitoring occurred in 34 and 8 patients, respectively. CONCLUSIONS: Postoperative hypotension and hypertension were common, prolonged, profound, and largely undetected by routine vital-sign assessments in a cohort of adults recovering from abdominal surgery. Frequent or continuous blood pressure monitoring may detect hemodynamic perturbations more effectively and potentially facilitate treatment.
Authors: Jessica Spence; Yannick LeManach; Matthew TV Chan; C Y Wang; Alben Sigamani; Denis Xavier; Rupert Pearse; Pablo Alonso-Coello; Ignacio Garutti; Sadeesh K Srinathan; Emmanuelle Duceppe; Michael Walsh; Flavia Kessler Borges; German Malaga; Valsa Abraham; Atiya Faruqui; Otavio Berwanger; Bruce M Biccard; Juan Carlos Villar; Daniel I Sessler; Andrea Kurz; Clara K Chow; Carisi A Polanczyk; Wojciech Szczeklik; Gareth Ackland; Garg Amit X; Michael Jacka; Gordon H Guyatt; Robert J Sapsford; Colin Williams; Olga Lucia Cortes; Pierre Coriat; Ameen Patel; Maria Tiboni; Emilie P Belley-Côté; Stephen Yang; Diane Heels-Ansdell; Michael McGillion; Simon Parlow; Matthew Patel; Shirley Pettit; Salim Yusuf; P J Devereaux Journal: CMAJ Date: 2019-07-29 Impact factor: 8.262
Authors: Walter Nelson; Shuang Di; Sankavi Muralitharan; Michael McGillion; P J Devereaux; Neil Grant Barr; Jeremy Petch Journal: J Med Internet Res Date: 2021-02-04 Impact factor: 5.428
Authors: Alexis Paternot; Philippe Aegerter; Aurélie Martin; Jonathan Ouattara; Sabrina Ma; Sherifa Adjavon; Bernard Trillat; Pascal Alfonsi; Marc Fischler; Morgan Le Guen Journal: F1000Res Date: 2021-07-21
Authors: Michael McGillion; Carley Ouellette; Amber Good; Marissa Bird; Shaunattonie Henry; Wendy Clyne; Andrew Turner; Paul Ritvo; Sarah Ritvo; Nazari Dvirnik; Andre Lamy; Richard Whitlock; Christopher Lawton; Jake Walsh; Ken Paterson; Janine Duquette; Karla Sanchez Medeiros; Fadi Elias; Ted Scott; Joseph Mills; Deborah Harrington; Mark Field; Prathiba Harsha; Stephen Yang; Elizabeth Peter; Sanjeev Bhavnani; P J Devereaux Journal: J Med Internet Res Date: 2020-03-18 Impact factor: 5.428
Authors: Christian Reiterer; Barbara Kabon; Alexander Taschner; Oliver Zotti; Andrea Kurz; Edith Fleischmann Journal: BMC Anesthesiol Date: 2020-08-04 Impact factor: 2.217