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Individualized BP target reduces risk for organ dysfunction after surgery
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Among patients at risk for postoperative complications who underwent surgery, an individualized BP management strategy reduced organ dysfunction compared with a standard management strategy, according to a study.
For the INPRESS study, 298 patients (mean age, 70 years; 15% women) with elevated risk for postoperative complications and a preoperative acute kidney injury risk of class III or higher who underwent major surgery for at least 2 hours under general anesthesia were randomly assigned to an individualized or a standard BP management strategy.
The individualized strategy targeted achievement of a systolic BP within 10% of a patient’s preoperative resting systolic BP. The standard strategy aimed to treat systolic BP less than 80 mm Hg or lower than 40% of preoperative resting systolic BP during and up to 4 hours after surgery, Emmanuel Futier, MD, PhD, from the department of perioperative medicine, Universite Clermont Auvergne, Centre national de la recherche scientifique, Inserm, Centre Hospitalier Universitaire Clermont-Ferrand, France, and colleagues wrote in JAMA.
The primary outcome was a composite at 7 days of systemic inflammatory response syndrome and dysfunction of at least one of the following organ systems: renal, respiratory, CV, coagulation and neurologic.
Among the cohort, 292 patients completed the trial and were included in a modified intention-to-treat analysis.
The primary outcome occurred in 38.1% of patients assigned to the individualized treatment strategy vs. 51.7% assigned to the standard treatment strategy (RR = 0.73; 95% CI, 0.56-0.94; absolute risk difference, –14%; 95% CI, –25 to –2), according to the researchers.
At 30 days, postoperative organ dysfunction occurred in 46.3% of those in the individualized group and 63.4% in the standard group (HR = 0.66; 95% CI, 0.52-0.84), Futier and colleagues wrote.
The groups did not differ in severe adverse events or 30-day mortality.
In a related editorial, Solomon Aronson, MD, from the department of anesthesiology at Duke University Medical Center, and Monty G. Mythen, MBBS, MD, FRCA, FFICM, FCAI(Hon), from the University College London Hospitals National Institute for Health Research Biomedical Research Centre, wrote: “The findings from this well-done trial suggest that a personalized baseline BP is an important consideration when defining an intraoperative BP target and that active management with combination [beta- and alpha-]agonist pharmacologic intervention is a reasonable and perhaps useful practice.” – by Erik Swain
Disclosures: The study was sponsored in part by a grant from Aguettant. Futier reports he consults for Drager and Edwards Lifesciences, receives lecture fees from Drager, Fisher, Fresenius Kabi and GE Healthcare, and received travel reimbursement from Fisher and Paykel Healthcare. Please see the study for the other authors’ relevant financial disclosures. Aronson reports he consults for Chiesi USA, GeNO LLC and Pfizer, serves on the executive advisory committee for GeNO LLC and serves as chief medical adviser to Summus Global LLC. Mythen reports his chair is sponsored by Smiths Medical and he consults for Deltex Medical and Edwards Lifesciences.
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