Personalized perioperative blood pressure management in patients having major non-cardiac surgery: A bicentric pilot randomized trial

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-11-27 DOI:10.1016/j.jclinane.2024.111687

Alina Bergholz , Linda Grüßer , Wiam T.A.K. Khader , Pawel Sierzputowski , Linda Krause , Marc Hein , Julia Wallqvist , Sebastian Ziemann , Kristen K. Thomsen , Moritz Flick , Philipp Breitfeld , Moritz Waldmann , Ana Kowark , Mark Coburn , Karim Kouz , Bernd Saugel

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Abstract

Study objective

We hypothesize that personalized perioperative blood pressure management maintaining intraoperative mean arterial pressure (MAP) above the preoperative mean nighttime MAP reduces perfusion-related organ injury compared to maintaining intraoperative MAP above 65 mmHg in patients having major non-cardiac surgery. Before testing this hypothesis in a large-scale trial, we performed this bicentric pilot trial to determine a) if performing preoperative automated nighttime blood pressure monitoring to calculate personalized intraoperative MAP targets is feasible; b) in what proportion of patients the preoperative mean nighttime MAP clinically meaningfully differs from a MAP of 65 mmHg; and c) if maintaining intraoperative MAP above the preoperative mean nighttime MAP is feasible in patients having major non-cardiac surgery.

Design

Bicentric pilot randomized trial.

Setting

University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and RWTH Aachen University Hospital, Aachen, Germany.

Patients

Patients ≥ 45 years old having major non-cardiac surgery.

Interventions

Personalized blood pressure management.

Measurements

Proportion of patients in whom preoperative automated nighttime blood pressure monitoring was possible; proportion of patients in whom the preoperative mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg (difference > ±10 mmHg); intraoperative time-weighted average MAP below the preoperative mean nighttime MAP.

Main results

We enrolled 105 patients and randomized 98 patients. In 98 patients (93 %), preoperative automated nighttime blood pressure monitoring was possible. In 83 patients (85 %), the preoperative mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg. The median time-weighted average MAP below the preoperative mean nighttime MAP was 3.29 (1.64, 6.82) mmHg in patients assigned to personalized blood pressure management.

Conclusions

It seems feasible to determine the effect of personalized perioperative blood pressure management maintaining intraoperative MAP above the preoperative mean nighttime MAP on postoperative complications in a large multicenter trial.

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非心脏大手术患者围手术期个性化血压管理：双中心试点随机试验

研究目的我们假设，与将术中平均动脉压（MAP）维持在 65 mmHg 以上相比，将术中平均动脉压（MAP）维持在术前夜间平均动脉压（MAP）以上的个性化围术期血压管理可减少非心脏大手术患者的灌注相关器官损伤。在大规模试验中检验这一假设之前，我们进行了这项双中心试点试验，以确定：a）通过术前自动夜间血压监测来计算个性化术中 MAP 目标是否可行；b）在多大比例的患者中，术前夜间平均 MAP 与 65 mmHg 的 MAP 存在临床意义上的差异；以及 c）在进行重大非心脏手术的患者中，将术中 MAP 维持在高于术前夜间平均 MAP 的水平是否可行。地点德国汉堡汉堡-埃彭多夫大学医疗中心和德国亚琛工业大学医院。干预措施个性化血压管理。测量术前可进行夜间自动血压监测的患者比例；术前夜间平均血压与 65 mmHg（差值> ±10mmHg）血压存在临床意义上的差异的患者比例；术中时间加权平均血压低于术前夜间平均血压的患者比例。98名患者（93%）可以进行术前夜间自动血压监测。有 83 名患者（85%）的术前夜间平均血压与 65 mmHg 的血压存在临床意义上的差异。中位时间加权平均血压低于术前平均夜间血压 3.29 (1.64, 6.82) mmHg。结论在一项大型多中心试验中，确定围术期个性化血压管理将术中血压维持在术前平均夜间血压以上对术后并发症的影响似乎是可行的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.