Arterial Catheters for Early Detection and Treatment of Hypotension During Major Noncardiac Surgery: A Randomized Trial
| Autor: | Matthew T. Hutcherson, Iman Suleiman, Daniel I. Sessler, Bianka M Nguyen, Hesham Elsharkawy, Ashish Khanna, Andrea Kurz, Dongsheng Yang, Devan Cote, Edward J. Mascha, Eric M. Reville, Amanda J. Naylor, Kamal Maheshwari |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Mean arterial pressure Catheters Early detection Sensitivity and Specificity law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law Monitoring Intraoperative Oscillometry Humans Medicine Arterial Pressure Intraoperative Complications Aged Models Statistical business.industry Area under the curve Middle Aged Arterial catheter Catheter Early Diagnosis Treatment Outcome Anesthesiology and Pain Medicine Pressure measurement Blood pressure Area Under Curve Surgical Procedures Operative Anesthesia Female Hypotension business 030217 neurology & neurosurgery |
| Zdroj: | Anesthesia & Analgesia. 131:1540-1550 |
| ISSN: | 0003-2999 |
| DOI: | 10.1213/ane.0000000000004370 |
| Popis: | Continuous blood pressure monitoring may facilitate early detection and prompt treatment of hypotension. We tested the hypothesis that area under the curve (AUC) mean arterial pressure (MAP)65 mm Hg is reduced by continuous invasive arterial pressure monitoring.Adults having noncardiac surgery were randomly assigned to continuous invasive arterial pressure or intermittent oscillometric blood pressure monitoring. Arterial catheter pressures were recorded at 1-minute intervals; oscillometric pressures were typically recorded at 5-minute intervals. We estimated the arterial catheter effect on AUC-MAP65 mm Hg using a multivariable proportional odds model adjusting for imbalanced baseline variables and duration of surgery. Pressures65 mm Hg were categorized as 0, 1-17, 18-91, and91 mm Hg × minutes of AUC-MAP65 mm Hg (ie, no hypotension and 3 equally sized groups of increasing hypotension).One hundred fifty-two patients were randomly assigned to arterial catheter use and 154 to oscillometric monitoring. For various clinical reasons, 143 patients received an arterial catheter, while 163 were monitored oscillometrically. There were a median [Q1, Q3] of 246 [187, 308] pressure measurements in patients with arterial catheters versus 55 (46, 75) measurements in patients monitored oscillometrically. In the primary intent-to-treat analysis, catheter-based monitoring increased detection of AUC-MAP65 mm Hg, with an estimated proportional odds ratio (ie, odds of being in a worse hypotension category) of 1.78 (95% confidence interval [CI], 1.18-2.70; P = .006). The result was robust over an as-treated analysis and for sensitivity analyses with thresholds of 60 and 70 mm Hg.Intraoperative blood pressure monitoring with arterial catheters detected nearly twice as much hypotension as oscillometric measurements. |
| Databáze: | OpenAIRE |
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