scholarly journals The impact of intraoperative blood pressure variability on the risk of postoperative adverse outcomes in non-cardiac surgery: a systematic review

2022 ◽  
Author(s):  
Zbigniew Putowski ◽  
Marcelina Czok ◽  
Łukasz J. Krzych
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Blood Pressure Variability ◽  
Pressure Variation ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Medical Subject Headings ◽  
Blood Pressure Variation ◽  
The Impact

AbstractHemodynamic stability during surgery seems to account for positive postoperative outcomes in patients. However, little is known about the impact of intraoperative blood pressure variability (IBPV) on the postoperative complications. The aim was to investigate whether IBPV is associated with the development of postoperative complications and what is the nature of this association. We conducted a systematic search in PubMed, Medical Subject Headings, Embase, Web of Science, SCOPUS, clinicaltrials.gov, and Cochrane Library on the 8th of April, 2021. We included studies that only focused on adults who underwent primarily elective, non-cardiac surgery in which intraoperative blood pressure variation was measured and analyzed in regard to postoperative, non-surgical complications. We identified 11 papers. The studies varied in terms of applied definitions of blood pressure variation, of which standard deviation and average real variability were the most commonly applied definitions. Among the studies, the most consistent analyzed outcome was a 30-day mortality. The studies presented highly heterogeneous results, even after taking into account only the studies of best quality. Both higher and lower IBPV were reported to be associated for postoperative complications. Based on a limited number of studies, IBPV does not seem to be a reliable indicator in predicting postoperative complications. Existing premises suggest that either higher or lower IBPV could contribute to postoperative complications. Taking into account the heterogeneity and quality of the studies, the conclusions may not be definitive.

[OP.4A.07] THE IMPACT OF BLOOD PRESSURE VARIABILITY ON ADVERSE OUTCOMES AFTER KIDNEY TRANSPLANTATION

2016 ◽  
Vol 34 ◽  
pp. e42 ◽  
Author(s):  
N. Pagonas ◽  
F. Seibert ◽  
F. Bauer ◽  
K. Markakis ◽  
M. Seidel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Transplantation ◽  
Blood Pressure Variability ◽  
Adverse Outcomes ◽  
The Impact

A Family Study of Developmental Effects upon Blood Pressure Variation

1987 ◽  
Vol 36 (4) ◽  
pp. 467-473 ◽  
Author(s):  
J. Sims ◽  
D. Carroll ◽  
J.K. Hewitt ◽  
J.R. Turner
Keyword(s):  
Blood Pressure ◽  
Family Study ◽  
Model Fitting ◽  
Pressure Variation ◽  
Age Group ◽  
Developmental Effects ◽  
Blood Pressure Variation ◽  
Likelihood Model ◽  
Salient Factor ◽  
The Impact

AbstractIn an earlier study of blood pressure variation in middle aged parents and their young adult twin offspring, the greater blood pressure variation observed in the parent sample was accounted for in terms of an increasing influence of individual environmental experiences with increasing age and a commensurate reduction in the impact of heredity. In the present study, the sample size was enlarged to provide a more powerful test of these effects. Maximum likelihood model-fitting techniques were applied to blood pressure covariation in balanced pedigrees, consisting of 85 families (40 MZ and 45 DZ twin pairs). As before, our analysis indicated that a developmental effect was a salient factor in the older age group.

scholarly journals The correlation of blood pressure variability and cognitive function in hypertension patients: a meta-analysis

2021 ◽  
Author(s):  
Xiaojie Jin ◽  
Yi Lu ◽  
Peng Zhao
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Blood Pressure Variability ◽  
Meta Analysis ◽  
Case Control ◽  
Pressure Variation ◽  
Case Control Studies ◽  
Hypertensive Patients ◽  
Blood Pressure Variation

Background: Cognitive impairment is very common in patients with hypertension, it’s necessary to conduct a meta-analysis to evaluate the association of cognitive function and blood pressure variability in patients with hypertension, to provide insights into the clinical management of hypertension and cognitive impairment. Methods: We searched PubMed et al databases for the case-control studies on the association between blood pressure variability and cognitive function up to July 15, 2021. Two researchers independently screened the literature and retrieved the data. RevMan 5.3 was used for data meta-analysis Results: A total of 13 studies involving 2754 patients were included. Meta-analysis indicated that 24-hour systolic [MD= 3.54, 95% CI (2.48, 4.60)] and diastolic [MD=2.43, 95%CI (1.55, 3.31)] blood pressure variation coefficient in the CI group were significantly higher than that of no CI group (all P<0.05). Standard deviation of systolic [MD=2.20, 95% CI (0.27, 4.13)] and diastolic [MD=1.79, 95% CI (0.80, 2.79)] blood pressure variation in the CI group were significantly higher than that of no CI group (all P<0.05). Mean systolic [MD=3.73, 95% CI (0.92, 6.53)]and diastolic [MD = 5.41, 95% CI (0.42, 10.40)] blood pressure variation in the CI group were significantly higher than that of no CI group (all P<0.05). There were no statistically significant differences in the morning peak systolic [MD=7.85,95% CI (-1.30,17.01)] and diastolic [MD=4.44,95% CI (-6.00, 14.89)] blood pressure drop between the CI group and no CI group(all P>0.05). Conclusion: Cognitive impairment in hypertensive patients is closely associated with increased blood pressure variability, and clinical medical staff should pay attention to the management of blood pressure variability in hypertensive patients to reduce the development of cognitive impairments.

scholarly journals Intraoperative Blood Pressure Variability Predicts Postoperative Mortality in Non-Cardiac Surgery—A Prospective Observational Cohort Study

2019 ◽  
Vol 16 (22) ◽  
pp. 4380
Author(s):  
Agnieszka Wiórek ◽  
Łukasz J. Krzych
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Blood Pressure Variability ◽  
Prospective Observational Study ◽  
Outcome Prediction ◽  
Clinical Importance ◽  
Postoperative Mortality ◽  
Coefficients Of Variation ◽  
Observational Cohort ◽  
The Impact

Little is known about the clinical importance of blood pressure variability (BPV) during anesthesia in non-cardiac surgery. We sought to investigate the impact of intraoperative BPV on postoperative mortality in non-cardiac surgery subjects, taking into account patient- and procedure-related variables. This prospective observational study covered 835 randomly selected patients who underwent gastrointestinal (n = 221), gynecological (n = 368) and neurosurgical (n = 246) procedures. Patient’s and procedure’s risks were assessed according to the validated tools and guidelines. Blood pressure (systolic, SBP, and diastolic, DBP) was recorded in five-minute intervals during anesthesia. Mean arterial pressure (MAP) was assessed. Individual coefficients of variation (Cv) were calculated. Postoperative 30-day mortality was considered the outcome. Median SBP_Cv was 11.2% (IQR 8.4–14.6), DBP_Cv was 12.7% (IQR 9.8–16.3) and MAP_Cv was 10.96% (IQR 8.26–13.86). Mortality was 2%. High SBP_Cv (i.e., ≥11.9%) was associated with increased mortality by 4.5 times (OR = 4.55; 95% CI 1.48–13.93; p = 0.008). High DBP_Cv (i.e., ≥22.4%) was associated with increased mortality by nearly 10 times (OR = 9.73; 95% CI 3.26–28.99; p < 0.001). High MAP_Cv (i.e., ≥13.6%) was associated with increased mortality by 3.5 times (OR = 3.44; 95% CI 1.34–8.83; p = 0.01). In logistic regression, it was confirmed that the outcome was dependent on both SBPV and DBPV, after adjustment for perioperative variables, with AUCSBP_Cv = 0.884 (95% CI 0.859–0.906; p < 0.001) and AUCDBP_Cv = 0.897 (95% CI 0.873–0.918; p < 0.001). Therefore, intraoperative BPV may be considered a prognostic factor for the postoperative mortality in non-cardiac surgery, and DBPV seems more accurate in outcome prediction than SBPV.

scholarly journals Impact of home telemonitoring and management support on blood pressure control in non-dialysis CKD: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044195
Author(s):  
Ikechi G Okpechi ◽  
Shezel Muneer ◽  
Mohammed M Tinwala ◽  
Deenaz Zaidi ◽  
Laura N Hamonic ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Kidney Disease ◽  
Grey Literature ◽  
Public Health Problem ◽  
Home Blood Pressure ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Management Support ◽  
The Impact

IntroductionHypertension is a common public health problem and a key modifiable risk factor for cardiovascular (CV) and chronic kidney disease (CKD). Home blood pressure (BP) telemonitoring (HBPT) and management is associated with improved BP control, accelerated delivery of care and decision-making strategies that can reduce adverse outcomes associated with hypertension. The aim of this paper is to describe the protocol for a systematic review to assess the impact of HBPT interventions used for improving BP control and reducing CV and kidney outcomes in non-dialysis CKD patients.MethodsWe developed this protocol using the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015. We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO and grey literature for studies conducted in non-dialysis CKD patients on interventions using HBPT and reporting outcomes related to BP control and other outcomes such as CV events and kidney disease progression. All studies meeting these criteria, in adults and published from inception until 2020 with no language barrier will be included.Ethics and disseminationEthical approval will not be required for this review as the data used will be extracted from already published studies with publicly accessible data. As this study will assess the impact of HBPT on BP control in non-dialysis CKD patients, evidence gathered through it will be disseminated using traditional approaches that includes open-access peer-reviewed publication, scientific presentations and a report. We will also disseminate our findings to appropriate government agencies.PROSPERO registration numberCRD42020190705).

The impact of exogenous nitric oxide during cardiopulmonary bypass for cardiac surgery

Perfusion ◽  
2021 ◽  
pp. 026765912110148
Author(s):  
Joseph Mc Loughlin ◽  
Lorraine Browne ◽  
John Hinchion
Keyword(s):  
Nitric Oxide ◽  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Troponin I ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
High Quality Research ◽  
Low Cardiac Output Syndrome ◽  
The Impact

Objectives: Cardiac surgery using cardiopulmonary bypass frequently provokes a systemic inflammatory response syndrome. This can lead to the development of low cardiac output syndrome (LCOS). Both of these can affect morbidity and mortality. This study is a systematic review of the impact of gaseous nitric oxide (gNO), delivered via the cardiopulmonary bypass (CPB) circuit during cardiac surgery, on post-operative outcomes. It aims to summarise the evidence available, to assess the effectiveness of gNO via the CPB circuit on outcomes, and highlight areas of further research needed to develop this hypothesis. Methods: A comprehensive search of Pubmed, Embase, Web of Science and the Cochrane Library was performed in May 2020. Only randomised control trials (RCTs) were considered. Results: Three studies were identified with a total of 274 patients. There was variation in the outcomes measures used across the studies. These studies demonstrate there is evidence that this intervention may contribute towards cardioprotection. Significant reductions in cardiac troponin I (cTnI) levels and lower vasoactive inotrope scores were seen in intervention groups. A high degree of heterogeneity between the studies exists. Meta-analysis of the duration of mechanical ventilation, length of ICU stay and length of hospital stay showed no significant differences. Conclusion: This systematic review explored the findings of three pilot RCTs. Overall the hypothesis that NO delivered via the CPB circuit can provide cardioprotection has been supported by this study. There remains a significant gap in the evidence, further high-quality research is required in both the adult and paediatric populations.

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