Association between intraoperative mean arterial pressure and postoperative complications is independent of cardiac index in patients undergoing noncardiac surgery

Maheshwari, Kamal; Pu, Xuan; Rivas, Eva; Saugel, Bernd; Turan, Alparslan; Schmidt, Marc T.; Ruetzler, Kurt; Reiterer, Christian; Kabon, Barbara; Kurz, Andrea; Sessler, Daniel I.

doi:10.1016/j.bja.2021.06.024

Cited by 10 publications

(15 citation statements)

References 10 publications

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“…These treatment algorithms first optimize stroke volume with fluid boluses and then, if hypotension persists, add a vasopressor to maintain MBP > 65 mmHg. This management reflects the increasing evidence that perioperative hypotension is associated with harm and should be avoided [ 294 , 296 , 297 ].…”

Section: Perioperative Interventionsmentioning

confidence: 93%

“…Approximately one-third of these hypotensive events occurred before the surgical incision. There is increasing evidence from large retrospective database reviews showing that even a short duration of hypotension is associated with myocardial injury and acute kidney injury [293][294][295] and that the severity of injury is associated with both the duration and degree of hypotension [294,296]. One major prospective interventional trial showed a significant reduction in complications (38% versus 51%, p = 0.02) with individualized blood pressure management (n = 147) compared with standard pressure management (n = 245) [297].…”

Section: Intraoperative Hypotension Should Be Avoided As Even Short D...mentioning

confidence: 99%

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Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons

et al. 2022

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The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence. While not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and was approved by both societies. Keywords Enhanced recovery • Colorectal surgery • ERAS Statement of the problemColorectal surgery has historically been associated with long postoperative hospital stays, high costs, and surgical site infection rates approaching 20% [1, 2]. In addition, the incidence of in-hospital perioperative nausea and vomiting (PONV) may be as high as 80% [3] and readmission rates are as high as 35% [4]. Enhanced recovery protocols (ERPs) are a set of standardized perioperative processes, the content of which may vary significantly, that are applied to patients undergoing elective surgery. In general, these protocols are not intended for non-elective cases, but components of ERPs could certainly be applied to the emergent/urgent patient [5, 6]. Also known as "fast track" or "enhanced recovery after surgery" (ERAS) protocols, enhanced recovery protocols This publication was approved by both the ASCRS and SAGES executive council and then peer reviewed by the Diseases of the Colon & Rectum and Surgical Endoscopy And Other Interventional Techniques. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article. In order to encourage its wide dissemination this article is freely accessible on Surgical Endoscopy And Other In...

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Section: Perioperative Interventionsmentioning

confidence: 93%

Section: Intraoperative Hypotension Should Be Avoided As Even Short D...mentioning

confidence: 99%

Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons

et al. 2022

View full text Add to dashboard Cite

show abstract

“…This management reflects the increasing evidence that perioperative hypotension is associated with harm and should be avoided. 294 , 296 , 297 …”

Section: Perioperative Interventionsmentioning

confidence: 99%

“…There is increasing evidence from large retrospective database reviews showing that even a short duration of hypotension is associated with myocardial injury and AKI [293][294][295] and that the severity of injury is associated with both the duration and degree of hypotension. 294,296 One major prospective interventional trial showed a significant reduction in complications (38% versus 51%; p = 0.02) with individualized blood pressure management (n = 147) compared with standard pressure management (n = 245). 297 In this study, patients in the intervention group had their fluid status optimized and then had a vasopressor infused to maintain their systolic blood pressure within 10% of their resting blood pressure.…”

Section: Intraoperative Hypotension Should Be Avoided As Even Short D...mentioning

confidence: 99%

Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons

Irani

Hedrick

Miller

et al. 2022

Diseases of the Colon &Amp; Rectum

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Funding/Support: None reported.Financial Disclosure: The funding bodies (ASCRS and SAGES) did not influence the content of this work, and no other specific funding was received from other entities. This publication was approved by both the ASCRS and SAGES executive council and then peer-reviewed by the Diseases of the Colon & Rectum and Surgical Endoscopy And Other Interventional Techniques. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article. In order to encourage its wide dissemination, this article is freely accessible on Surgical Endoscopy And Other Interventional Techniques and Diseases of the Colon & Rectum journal web sites.

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“…101 However a recent sub-analysis of the CrystalloideColloid Study found that the worse outcomes associated with hypotension were independent of cardiac index in noncardiac surgery patients. 102…”

Section: Importance Of Cardiac Output To Organ Perfusionmentioning

confidence: 99%

Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review

Meng

2021

British Journal of Anaesthesia

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Association between intraoperative mean arterial pressure and postoperative complications is independent of cardiac index in patients undergoing noncardiac surgery

Cited by 10 publications

References 10 publications

Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons

Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons

Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons

Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review

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