Effect of strict intraoperative blood pressure management strategy on postoperative acute kidney injury in non‐cardiac surgery: A meta‐analysis of randomised controlled trials

Autor: Yi-Heng Liu, Meng Deng, Shu Hong, Meng-Yun Tu, Jia Lu
Rok vydání: 2021
Předmět:
Zdroj: International Journal of Clinical Practice. 75
ISSN: 1742-1241
1368-5031
DOI: 10.1111/ijcp.14570
Popis: Background Acute kidney injury (AKI) is one of the most serious perioperative complications. 20% to 40% of high-risk patients who undergo non-cardiac surgery have AKI and those with AKI are eight-times more likely to die within 30 days after surgery. It may be related to intraoperative hypotension, which is mainly caused by vasodilatory and cardiodepressant effects of anaesthesia, and/or hypovolemia. Strict intraoperative blood pressure management strategy (strict BP management) is a potential option to prevent postoperative AKI. This strategy refers to additional administration of vasoactive agents under the premise of a protocolized fluid delivery. The efficacy of strict BP management for preventing postoperative AKI in non-cardiac surgery patients was assessed by a meta-analysis. Methods We systematically retrieved randomised controlled trials (RCTs) compared strict BP management with conventional therapy control on effect of postoperative AKI in non-cardiac surgery patients, which were published on PubMed, EMBASE, Cochrane library, and Web of Science databases before October 5, 2020. Ultimately, a meta-analysis of all RCTs eligible for inclusion criteria was performed. Results Five RCTs, comprising 1485 patients, were included inthe meta-analysis. Strict BP management was associated with a reduced incidence of postoperative AKI [relative risk (RR) = 0.73, 95% confidence interval (CI) 0.58-0.92, P = .007]. No significant difference was found between strict BP management group and conventional therapy control in mortality at longest follow-up available (RR = 0.92, 95% CI 0.68-1.25, P = .60). In the subset analysis, the studies using supranormal BP management target was significantly lower in the incidence of postoperative AKI (RR = 0.65, 95% CI 0.51-0.82, P = .0003) CONCLUSION: Strict BP management is significantly more effective than conventional therapy for the prevention of postoperative AKI. Supranormal target of intraoperative blood pressure management may be considered a more appealing option for the prevention of AKI.
Databáze: OpenAIRE
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