Alexandre Joosten1, Dragos Chirnoaga2, Philippe Van der Linden3, Luc Barvais2, Brenton Alexander4, Jacques Duranteau5, Jean-Louis Vincent6, Maxime Cannesson7, Joseph Rinehart8. 1. Department of Anaesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France. Electronic address: Alexandre.Joosten@erasme.ulb.ac.be. 2. Department of Anaesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. 3. Department of Anaesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium. 4. Department of Anesthesiology, University of California San Diego, San Diego, CA, USA. 5. Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France. 6. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. 7. Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. 8. Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA.
Abstract
BACKGROUND: Hypotension occurs frequently during surgery and may be associated with adverse complications. Vasopressor titration is frequently used to correct hypotension, but requires considerable time and attention, potentially reducing the time available for other clinical duties. To overcome this issue, we have developed a closed-loop vasopressor (CLV) controller to help correct hypotension more efficiently. The aim of this randomised controlled study was to evaluate whether the CLV controller was superior to traditional vasopressor management at minimising hypotension in patients undergoing abdominal surgery. METHODS: Thirty patients scheduled for elective intermediate-to high-risk abdominal surgery were randomised into two groups. In the CLV group, hypotension was corrected automatically via the CLV controller system, which adjusted the rate of a norepinephrine infusion according to MAP values recorded using an advanced haemodynamic device. In the control group, management of hypotension consisted of standard, manual adjustment of the norepinephrine infusion. The primary outcome was the percentage of time that a patient was hypotensive, defined as MAP <90% of their baseline value, during surgery. RESULTS: The percentage of time patients were hypotensive during surgery was 10 times less in the CVL group than in the control group (1.6 [0.9-2.3]% vs 15.4 [9.9-24.3]%; difference: 13 [95% confidence interval: 9-19]; P<0.0001). The CVL group also spent much less time with MAP <65 mm Hg (0.2 [0.0-0.4]% vs 4.5 [1.1-7.9]%; P<0.0001). CONCLUSIONS: In patients undergoing intermediate- to high-risk surgery under general anaesthesia, computer-assisted adjustment of norepinephrine infusion significantly decreases the incidence of hypotension compared with manual control. CLINICAL TRIAL REGISTRATION: NCT04089644.
BACKGROUND: Hypotension occurs frequently during surgery and may be associated with adverse complications. Vasopressor titration is frequently used to correct hypotension, but requires considerable time and attention, potentially reducing the time available for other clinical duties. To overcome this issue, we have developed a closed-loop vasopressor (CLV) controller to help correct hypotension more efficiently. The aim of this randomised controlled study was to evaluate whether the CLV controller was superior to traditional vasopressor management at minimising hypotension in patients undergoing abdominal surgery. METHODS: Thirty patients scheduled for elective intermediate-to high-risk abdominal surgery were randomised into two groups. In the CLV group, hypotension was corrected automatically via the CLV controller system, which adjusted the rate of a norepinephrine infusion according to MAP values recorded using an advanced haemodynamic device. In the control group, management of hypotension consisted of standard, manual adjustment of the norepinephrine infusion. The primary outcome was the percentage of time that a patient was hypotensive, defined as MAP <90% of their baseline value, during surgery. RESULTS: The percentage of time patients were hypotensive during surgery was 10 times less in the CVL group than in the control group (1.6 [0.9-2.3]% vs 15.4 [9.9-24.3]%; difference: 13 [95% confidence interval: 9-19]; P<0.0001). The CVL group also spent much less time with MAP <65 mm Hg (0.2 [0.0-0.4]% vs 4.5 [1.1-7.9]%; P<0.0001). CONCLUSIONS: In patients undergoing intermediate- to high-risk surgery under general anaesthesia, computer-assisted adjustment of norepinephrine infusion significantly decreases the incidence of hypotension compared with manual control. CLINICAL TRIAL REGISTRATION: NCT04089644.
Authors: Michael Walsh; Philip J Devereaux; Amit X Garg; Andrea Kurz; Alparslan Turan; Reitze N Rodseth; Jacek Cywinski; Lehana Thabane; Daniel I Sessler Journal: Anesthesiology Date: 2013-09 Impact factor: 7.892
Authors: Louise Y Sun; Amy M Chung; Michael E Farkouh; Sean van Diepen; Jesse Weinberger; Michael Bourke; Marc Ruel Journal: Anesthesiology Date: 2018-09 Impact factor: 7.892
Authors: Alexandre Joosten; Amelie Delaporte; Brigitte Ickx; Karim Touihri; Ida Stany; Luc Barvais; Luc Van Obbergh; Patricia Loi; Joseph Rinehart; Maxime Cannesson; Philippe Van der Linden Journal: Anesthesiology Date: 2018-01 Impact factor: 7.892
Authors: Alexandre Joosten; Joseph Rinehart; Philippe Van der Linden; Brenton Alexander; Christophe Penna; Jacques De Montblanc; Maxime Cannesson; Jean-Louis Vincent; Eric Vicaut; Jacques Duranteau Journal: Anesthesiology Date: 2021-08-01 Impact factor: 8.986