Perioperative Quality Initiative consensus statement on intraoperative blood pressure,risk and outcomes for elective surgery |
| |
| Authors: | Daniel I. Sessler Joshua A. Bloomstone Solomon Aronson Colin Berry Tong J. Gan John A. Kellum James Plumb Monty G. Mythen Michael P.W. Grocott Mark R. Edwards Timothy E. Miller Timothy E. Miller Monty G. Mythen Michael PW. Grocott Mark R. Edwards |
| |
| Affiliation: | 1. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland OH, USA;2. University of Arizona College of Medicine–Phoenix, Phoenix, AZ, USA;3. Division of Surgery and Interventional Sciences, University College London, London, UK;4. Envision Physician Services, Plantation, FL, USA;5. Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA;6. Royal Devon and Exeter NHS Foundation Trust, Exeter, UK;7. Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA;8. Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;9. Department of Anaesthesia, University College London, London, UK;10. UCL/UCLH National Institute of Health Research Biomedical Research Centre, London, UK;11. Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK;12. Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK;13. Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK |
| |
| Abstract: | BackgroundIntraoperative mortality is now rare, but death within 30 days of surgery remains surprisingly common. Perioperative myocardial infarction is associated with a remarkably high mortality. There are strong associations between hypotension and myocardial injury, myocardial infarction, renal injury, and death. Perioperative arterial blood pressure management was thus the basis of a Perioperative Quality Initiative consensus-building conference held in London in July 2017.MethodsThe meeting featured a modified Delphi process in which groups addressed various aspects of perioperative arterial pressure.ResultsThree consensus statements on intraoperative blood pressure were established. 1) Intraoperative mean arterial pressures below 60–70 mm Hg are associated with myocardial injury, acute kidney injury, and death. Injury is a function of hypotension severity and duration. 2) For adult non-cardiac surgical patients, there is insufficient evidence to recommend a general upper limit of arterial pressure at which therapy should be initiated, although pressures above 160 mm Hg have been associated with myocardial injury and infarction. 3) During cardiac surgery, intraoperative systolic arterial pressure above 140 mm Hg is associated with increased 30 day mortality. Injury is a function of arterial pressure severity and duration.ConclusionsThere is increasing evidence that even brief durations of systolic arterial pressure <100 mm Hg and mean arterial pressure <60–70 mm Hg are harmful during non-cardiac surgery. |
| |
| Keywords: | anaesthesia arterial pressure hypotension mortality myocardial injury postoperative outcome renal injury surgery |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
