Optimal blood pressure decreases acute kidney injury after gastrointestinal surgery in elderly hypertensive patients : A randomized study: Optimal blood pressure reduces acute kidney injury
Copyright © 2017 Elsevier Inc. All rights reserved..
STUDY OBJECTIVE: To determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period.
DESIGN: A prospective, randomized study.
SETTING: Three teaching hospitals in China.
PATIENTS: Six hundred seventy-eight elderly patients with chronic hypertension undergoing major gastrointestinal surgery.
INTERVENTIONS: Patients were randomly allocated to three groups and the target MAP level was strictly controlled to one of three levels: level I (65-79mmHg), level II (80-95mmHg), or level III (96-110mmHg).
MEASUREMENTS: The primary outcome was acute kidney injury (AKI) (50% or 0.3mg·dL-1increase in creatinine level) during the first 7 postoperative days. The secondary outcomes were perioperative adverse complications. Moreover, vasoactive agents were observed during surgery.
MAIN RESULTS: The overall incidence of postoperative AKI was 10.9% (71/648). AKI occurred significantly less often in patients with level II MAP control (6.3%;13/206) than in patients with level I (13.5%; 31/230) and level III (12.9%; 27/210) (P<0.001) MAP control. Level II was associated with lower incidences of hospital-acquired pneumonia (6.7%; 14/206; P=0.014) and admission to the intensive care unit (ICU) (4.4%; 9/206; P=0.015) and with shorter length of stay in the ICU (P=0.025) when compared with level I and level III. Use of norepinephrine, phenylephrine, and nitroglycerin was significantly higher for patients with level III MAP control than for patients with level I and level II MAP control (P=0.001).
CONCLUSIONS: For elderly hypertensive patients, controlling intraoperative MAP levels to 80 to 95mmHg can reduce postoperative AKI after major abdominal surgery.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:43 |
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| Enthalten in: |
Journal of clinical anesthesia - 43(2017) vom: 15. Dez., Seite 77-83 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wu, Xiujuan [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney injury |
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| Anmerkungen: |
Date Completed 10.07.2018 Date Revised 10.07.2018 published: Print-Electronic CommentIn: J Clin Anesth. 2018 Feb;44:97. - PMID 29169070 Citation Status MEDLINE |
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| doi: |
10.1016/j.jclinane.2017.09.004 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM27724191X |
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| 100 | 1 | |a Wu, Xiujuan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Optimal blood pressure decreases acute kidney injury after gastrointestinal surgery in elderly hypertensive patients |b A randomized study: Optimal blood pressure reduces acute kidney injury |
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| 500 | |a Date Completed 10.07.2018 | ||
| 500 | |a Date Revised 10.07.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Clin Anesth. 2018 Feb;44:97. - PMID 29169070 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2017 Elsevier Inc. All rights reserved. | ||
| 520 | |a STUDY OBJECTIVE: To determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period | ||
| 520 | |a DESIGN: A prospective, randomized study | ||
| 520 | |a SETTING: Three teaching hospitals in China | ||
| 520 | |a PATIENTS: Six hundred seventy-eight elderly patients with chronic hypertension undergoing major gastrointestinal surgery | ||
| 520 | |a INTERVENTIONS: Patients were randomly allocated to three groups and the target MAP level was strictly controlled to one of three levels: level I (65-79mmHg), level II (80-95mmHg), or level III (96-110mmHg) | ||
| 520 | |a MEASUREMENTS: The primary outcome was acute kidney injury (AKI) (50% or 0.3mg·dL-1increase in creatinine level) during the first 7 postoperative days. The secondary outcomes were perioperative adverse complications. Moreover, vasoactive agents were observed during surgery | ||
| 520 | |a MAIN RESULTS: The overall incidence of postoperative AKI was 10.9% (71/648). AKI occurred significantly less often in patients with level II MAP control (6.3%;13/206) than in patients with level I (13.5%; 31/230) and level III (12.9%; 27/210) (P<0.001) MAP control. Level II was associated with lower incidences of hospital-acquired pneumonia (6.7%; 14/206; P=0.014) and admission to the intensive care unit (ICU) (4.4%; 9/206; P=0.015) and with shorter length of stay in the ICU (P=0.025) when compared with level I and level III. Use of norepinephrine, phenylephrine, and nitroglycerin was significantly higher for patients with level III MAP control than for patients with level I and level II MAP control (P=0.001) | ||
| 520 | |a CONCLUSIONS: For elderly hypertensive patients, controlling intraoperative MAP levels to 80 to 95mmHg can reduce postoperative AKI after major abdominal surgery | ||
| 650 | 4 | |a Clinical Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute kidney injury | |
| 650 | 4 | |a Chronic hypertension | |
| 650 | 4 | |a Elderly patients | |
| 650 | 4 | |a Mean arterial pressure | |
| 650 | 4 | |a Risk factors | |
| 650 | 7 | |a Antihypertensive Agents |2 NLM | |
| 650 | 7 | |a Vasoconstrictor Agents |2 NLM | |
| 700 | 1 | |a Jiang, Zongming |e verfasserin |4 aut | |
| 700 | 1 | |a Ying, Jing |e verfasserin |4 aut | |
| 700 | 1 | |a Han, Yangyang |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Zhonghua |e verfasserin |4 aut | |
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