Mean arterial pressure versus cardiac index for haemodynamic management and myocardial injury after hepatopancreatic surgery

医学 心脏指数 血流动力学 血压 平均动脉压 麻醉 心脏病学 外科 心输出量 内科学 心率
作者
Taner Abdullah,Hürü Ceren Gökduman,İşbara Alp Enişte,İlyas Kudaş,Achmet Ali,Erdem Kınacı,İlgin Özden,Funda Gümüş Özcan
出处
期刊:European Journal of Anaesthesiology [Lippincott Williams & Wilkins]
卷期号:41 (11): 831-840 被引量:1
标识
DOI:10.1097/eja.0000000000002059
摘要

BACKGROUND Myocardial injury after noncardiac surgery (MINS) frequently complicates the peri-operative period and is associated with increased mortality. OBJECTIVE(S) We hypothesised that cardiac index (CI) based haemodynamic management reduces peri-operative high-sensitive troponin-T (hsTnT) elevation and MINS incidence in patients undergoing hepatic/pancreatic surgery compared to mean arterial pressure. DESIGN A randomised controlled study SETTING A single-centre study conducted in a university-affiliated tertiary hospital between June 2022 and March 2023. PATIENTS Ninety-one patients, who were ≥ 65 years old or ≥ 45 years old with a history of at least one cardiac risk factor were randomised to either mean arterial pressure (MAP) based ( n = 45) or CI-based ( n = 46) management groups, and completed the study. INTERVENTION(S) In group-MAP, patients received fluid boluses and/or a noradrenaline infusion to maintain MAP above the predefined threshold. In group-CI, patients received fluid boluses and/or dobutamine infusion to keep CI above the predefined threshold. When a low MAP was observed despite a normal CI, a noradrenaline infusion was started. MAIN OUTCOME MEASURES The primary outcome was peri-operative hsTnT elevation. The secondary outcomes were MINS incidence and 90-day mortality. RESULTS The median absolute troponin elevation was 4.3 ng l −1 (95% CI 3.4 to 6) for the CI-based group, and 9.4 ng l −1 (95% CI 7.7 to 12.7) for the MAP-based group (median difference: 5.1 ng l −1 , 95% CI 3 to 7; P < 0.001). MINS occurred in 8 (17.4%) patients in the CI-based group and 17 (37.8%) patients in the MAP-based group (relative risk: 0.46, 95% CI: 0.22 to 0.96; P = 0.029). Two patients in group-MAP died from cardiovascular-related causes. One patient in group-CI and two in group-MAP died from sepsis-related complications (for all-cause mortality: χ 2 = 1.98, P = 0.16). MAP-AUC and CI-AUC values of the CI- and MAP-based groups were 147 vs. 179 min × mmHg ( P = 0.85) and 8.4 vs. 43.2 l m −2 min −1 × min ( P < 0.001), respectively. CONCLUSIONS CI-based haemodynamic management assures sufficient flow and consequently is associated with less peri-operative hsTnT elevation and lower incidence of MINS compared to MAP. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05391087.
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