Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery.
View/ Open
Published version
Embargoed until: 5555-01-01
Embargoed until: 5555-01-01
Volume
122
Pagination
563 - 574
DOI
10.1016/j.bja.2019.01.013
Journal
Br J Anaesth
Issue
Metadata
Show full item recordAbstract
BACKGROUND: Intraoperative 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. METHODS: The meeting featured a modified Delphi process in which groups addressed various aspects of perioperative arterial pressure. RESULTS: Three 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. CONCLUSIONS: There 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.
Authors
Sessler, DI; Bloomstone, JA; Aronson, S; Berry, C; Gan, TJ; Kellum, JA; Plumb, J; Mythen, MG; Grocott, MPW; Edwards, MRCollections
Language
Related items
Showing items related by title, author, creator and subject.
-
Investigating the stratified efficacy and safety of pharmacological blood pressure-lowering: an overall protocol for individual patient-level data meta-analyses of over 300 000 randomised participants in the new phase of the Blood Pressure Lowering Treatment Trialists’ Collaboration (BPLTTC)
Rahimi, K; Canoy, D; Nazarzadeh, M; Salimi-Khorshidi, G; Woodward, M; Teo, K; Davis, BR; Chalmers, J; Pepine, CJ; Blood Pressure Lowering Treatment Trialists’ Collaboration. (BMJ Journals, 2019-05)INTRODUCTION: Previous research from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) and others has shown that pharmacological blood pressure (BP)- lowering substantially reduces the risk of major ... -
Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis
Rahimi, K; Bidel, Z; Nazarzadeh, M; Copland, E; Canoy, D; Wamil, M; Majert, J; McManus, RJ; Chalmers, J; Davis, BR (2021)