Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery.
Antihypertensive Agents
/ therapeutic use
Blood Pressure
/ physiology
Blood Pressure Determination
/ methods
Delphi Technique
Elective Surgical Procedures
/ adverse effects
Evidence-Based Medicine
/ methods
Humans
Hypertension
/ complications
Hypotension
/ complications
Perioperative Care
/ methods
Postoperative Complications
/ physiopathology
Prognosis
Risk Assessment
/ methods
antihypertensive drugs
blood pressure
hypertension
hypotension
myocardial infarction
outcomes
postoperative
surgery
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
29
03
2018
revised:
08
12
2018
accepted:
03
01
2019
pubmed:
28
3
2019
medline:
23
4
2019
entrez:
28
3
2019
Statut:
ppublish
Résumé
Postoperative hypotension and hypertension are frequent events associated with increased risk of adverse outcomes. However, proper assessment and management is often poorly understood. As a part of the PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed a consensus document addressing this topic. The target population includes adult, non-cardiac surgical patients in the postoperative phase outside of the ICU. A modified Delphi technique was used, evaluating papers published in MEDLINE examining postoperative blood pressure monitoring, management, and outcomes. Practice recommendations were developed in line with National Institute for Health and Care Excellence guidelines. Consensus recommendations were that (i) there is evidence of harm associated with postoperative systolic arterial pressure <90 mm Hg; (ii) for patients with preoperative hypertension, the threshold at which harm occurs may be higher than a systolic arterial pressure of 90 mm Hg; (iii) there is insufficient evidence to precisely define the level of postoperative hypertension above which harm will occur; (iv) a greater frequency of postoperative blood pressure measurement is likely to identify risk of harm and clinical deterioration earlier; and (v) there is evidence of harm from withholding beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors in the postoperative period. Despite evidence of associations with postoperative hypotension or hypertension with worse postoperative outcome, further research is needed to define the optimal levels at which intervention is beneficial, to identify the best methods and timing of postoperative blood pressure measurement, and to refine the management of long-term antihypertensive treatment in the postoperative phase.
Sections du résumé
BACKGROUND
BACKGROUND
Postoperative hypotension and hypertension are frequent events associated with increased risk of adverse outcomes. However, proper assessment and management is often poorly understood. As a part of the PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed a consensus document addressing this topic. The target population includes adult, non-cardiac surgical patients in the postoperative phase outside of the ICU.
METHODS
METHODS
A modified Delphi technique was used, evaluating papers published in MEDLINE examining postoperative blood pressure monitoring, management, and outcomes. Practice recommendations were developed in line with National Institute for Health and Care Excellence guidelines.
RESULTS
RESULTS
Consensus recommendations were that (i) there is evidence of harm associated with postoperative systolic arterial pressure <90 mm Hg; (ii) for patients with preoperative hypertension, the threshold at which harm occurs may be higher than a systolic arterial pressure of 90 mm Hg; (iii) there is insufficient evidence to precisely define the level of postoperative hypertension above which harm will occur; (iv) a greater frequency of postoperative blood pressure measurement is likely to identify risk of harm and clinical deterioration earlier; and (v) there is evidence of harm from withholding beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors in the postoperative period.
CONCLUSIONS
CONCLUSIONS
Despite evidence of associations with postoperative hypotension or hypertension with worse postoperative outcome, further research is needed to define the optimal levels at which intervention is beneficial, to identify the best methods and timing of postoperative blood pressure measurement, and to refine the management of long-term antihypertensive treatment in the postoperative phase.
Identifiants
pubmed: 30916008
pii: S0007-0912(19)30059-5
doi: 10.1016/j.bja.2019.01.019
pii:
doi:
Substances chimiques
Antihypertensive Agents
0
Types de publication
Consensus Development Conference
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
575-586Investigateurs
Gareth L Ackland
(GL)
Charles S Brudney
(CS)
Maurizio Cecconi
(M)
Can Ince
(C)
Michael G Irwin
(MG)
Jonathan Lacey
(J)
Michael R Pinsky
(MR)
Robert Sanders
(R)
Finton Hughes
(F)
Angela Bader
(A)
Annemarie Thompson
(A)
Andreas Hoeft
(A)
David Williams
(D)
Andrew D Shaw
(AD)
Daniel I Sessler
(DI)
Sol Aronson
(S)
Colin Berry
(C)
Tong J Gan
(TJ)
John Kellum
(J)
James Plumb
(J)
Joshua Bloomstone
(J)
Matthew D McEvoy
(MD)
Julie K M Thacker
(JKM)
Ruchir Gupta
(R)
Elena Koepke
(E)
Aarne Feldheiser
(A)
Denny Levett
(D)
Frederic Michard
(F)
Mark Hamilton
(M)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.