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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: Toward an empirical definition of hypotension
Anesthesiology, Volume 119, No. 3, Year 2013
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Description
BACKGROUND:: Intraoperative hypotension may contribute to postoperative acute kidney injury (AKI) and myocardial injury, but what blood pressures are unsafe is unclear. The authors evaluated the association between the intraoperative mean arterial pressure (MAP) and the risk of AKI and myocardial injury. METHODS:: The authors obtained perioperative data for 33,330 noncardiac surgeries at the Cleveland Clinic, Ohio. The authors evaluated the association between intraoperative MAP from less than 55 to 75 mmHg and postoperative AKI and myocardial injury to determine the threshold of MAP where risk is increased. The authors then evaluated the association between the duration below this threshold and their outcomes adjusting for potential confounding variables. RESULTS:: AKI and myocardial injury developed in 2,478 (7.4%) and 770 (2.3%) surgeries, respectively. The MAP threshold where the risk for both outcomes increased was less than 55 mmHg. Compared with never developing a MAP less than 55 mmHg, those with a MAP less than 55 mmHg for 1-5, 6-10, 11-20, and more than 20 min had graded increases in their risk of the two outcomes (AKI: 1.18 [95% CI, 1.06-1.31], 1.19 [1.03-1.39], 1.32 [1.11-1.56], and 1.51 [1.24-1.84], respectively; myocardial injury 1.30 [1.06-1.5], 1.47 [1.13-1.93], 1.79 [1.33-2.39], and 1.82 [1.31-2.55], respectively]. CONCLUSIONS:: Even short durations of an intraoperative MAP less than 55 mmHg are associated with AKI and myocardial injury. Randomized trials are required to determine whether outcomes improve with interventions that maintain an intraoperative MAP of at least 55 mmHg. Copyright © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.
Authors & Co-Authors
Walsh, Michael W.
Canada, Hamilton
Saint Joseph's Hospital Hamilton
Devereaux, Philip James
Canada, Hamilton
Mcmaster University
Garg, Amit X.
Canada, London
Western University
Kurz, Andrea M.
Unknown Affiliation
Turan, Alparslan M.
Unknown Affiliation
Rodseth, Reitze Nils
South Africa, Durban
University of Kwazulu-natal
Canada, Hamilton
Mcmaster University
Cywinski, J.
United States, Cleveland
Cleveland Clinic Foundation
Thabane, Lehana
Canada, Hamilton
Mcmaster University
Sessler, Daniel I.
Canada, Hamilton
Mcmaster University
Statistics
Citations: 1,111
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1097/ALN.0b013e3182a10e26
ISSN:
00033022
e-ISSN:
15281175
Research Areas
Health System And Policy
Violence And Injury