Recent studies show associations between intraoperative hypotension and increased risk of acute kidney injury (AKI) and myocardial injury 1-3 — the leading cause of post-operative mortality within 30 days after surgery.1
Prolonged exposures below mean arterial pressure (MAP) thresholds of 65 mmHg are associated with increased risk of myocardial injury and AKI after noncardiac surgery.1
Studies also show an increased risk of mortality associated with hypotension after noncardiac surgery.4,5
If it were considered its own category, post-operative mortality would be the third leading cause of death in the United States.6
Highlights from 2017 Salmasi, et al.1
Publication in Anesthesiology: “Relationship Between Intraoperative Hypotension, Defined by Either Reduction From Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury After Noncardiac Surgery”
In a study conducted by the Cleveland Clinic, researchers found that intraoperative hypotension is associated with clinical outcomes after noncardiac surgery.
Mean arterial pressure (MAP) below absolute thresholds of 65 mmHg or relative thresholds of 20% or more below baseline were progressively related to both myocardial and acute kidney injury (AKI). At any given threshold, prolonged exposure was associated with increased odds.
Absolute and relative MAP thresholds had comparable ability to discriminate patients with myocardial or kidney injury from those without. The results suggest that maintaining intraoperative MAP greater than 65 mmHg may reduce the risk of AKI and myocardial injury.
When managing perfusion, stroke volume can be “optimized” using the patient’s own Frank-Starling curve — a plot of stroke volume (SV) vs. preload.
The patients location on his or her Frank-Starling curve can be determined by measuring ∆SV in response to change in preload using:
Additionally, stroke volume variation (SVV) has been proven to be a highly sensitive and specific indicator for preload responsiveness when managing volume. As a dynamic parameter, SVV has been shown to be an accurate predictor of fluid responsiveness in loading conditions induced by mechanical ventilation.7,8,9
PGDT is a treatment protocol using dynamic and flow-based parameters with the objective of making the appropriate volume management decisions (e.g. fluid only when needed).7
PGDT can be implemented in a single procedure or as part of a larger initiative such as Enhanced Recovery After Surgery pathways.
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You may also be interested in learning more about fluid administration when managing perfusion.
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