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Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery  Daniel I. Sessler, Joshua.

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Presentation on theme: "Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery  Daniel I. Sessler, Joshua."— Presentation transcript:

1 Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery  Daniel I. Sessler, Joshua A. Bloomstone, Solomon Aronson, Colin Berry, Tong J. Gan, John A. Kellum, James Plumb, Monty G. Mythen, Michael P.W. Grocott, Mark R. Edwards, Timothy E. Miller, Timothy E. Miller, Monty G. Mythen, Michael PW. Grocott, Mark R. Edwards Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky Robert Sanders, Finton Hughes, Angela Bader, Annemarie Thompson, Andreas Hoeft, David Williams, Andrew D. Shaw Daniel I. Sessler, Sol Aronson, Colin Berry, Tong J. Gan, John Kellum, James Plumb, Joshua Bloomstone Matthew D. McEvoy, Julie K.M. Thacker, Ruchir Gupta, Elena Koepke, Aarne Feldheiser, Denny Levett, Frederic Michard, Mark Hamilton Daniel I. Sessler, Joshua A. Bloomstone, Solomon Aronson, Colin Berry, Tong J. Gan, John A. Kellum, James Plumb, Monty G. Mythen, Michael P.W. Grocott, Mark R. Edwards, Timothy E. Miller, Timothy E. Miller, Monty G. Mythen, Michael PW. Grocott, Mark R. Edwards Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky Robert Sanders, Finton Hughes, Angela Bader, Annemarie Thompson, Andreas Hoeft, David Williams, Andrew D. Shaw Daniel I. Sessler, Sol Aronson, Colin Berry, Tong J. Gan, John Kellum, James Plumb, Joshua Bloomstone Matthew D. McEvoy, Julie K.M. Thacker, Ruchir Gupta, Elena Koepke, Aarne Feldheiser, Denny Levett, Frederic Michard, Mark Hamilton Daniel I. Sessler, Joshua A. Bloomstone, Solomon Aronson, Colin Berry, Tong J. Gan, John A. Kellum, James Plumb, Monty G. Mythen, Michael P.W. Grocott, Mark R. Edwards, Timothy E. Miller, Timothy E. Miller, Monty G. Mythen, Michael PW. Grocott, Mark R. Edwards Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky Robert Sanders, Finton Hughes, Angela Bader, Annemarie Thompson, Andreas Hoeft, David Williams, Andrew D. Shaw Daniel I. Sessler, Sol Aronson, Colin Berry, Tong J. Gan, John Kellum, James Plumb, Joshua Bloomstone Matthew D. McEvoy, Julie K.M. Thacker, Ruchir Gupta, Elena Koepke, Aarne Feldheiser, Denny Levett, Frederic Michard, Mark Hamilton Daniel I. Sessler, Joshua A. Bloomstone, Solomon Aronson, Colin Berry, Tong J. Gan, John A. Kellum, James Plumb, Monty G. Mythen, Michael P.W. Grocott, Mark R. Edwards, Timothy E. Miller, Timothy E. Miller, Monty G. Mythen, Michael PW. Grocott, Mark R. Edwards Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky Robert Sanders, Finton Hughes, Angela Bader, Annemarie Thompson, Andreas Hoeft, David Williams, Andrew D. Shaw Daniel I. Sessler, Sol Aronson, Colin Berry, Tong J. Gan, John Kellum, James Plumb, Joshua Bloomstone Matthew D. McEvoy, Julie K.M. Thacker, Ruchir Gupta, Elena Koepke, Aarne Feldheiser, Denny Levett, Frederic Michard, Mark Hamilton Daniel I. Sessler, Joshua A. Bloomstone, Solomon Aronson, Colin Berry, Tong J. Gan, John A. Kellum, James Plumb, Monty G. Mythen, Michael P.W. Grocott, Mark R. Edwards, Timothy E. Miller, Timothy E. Miller, Monty G. Mythen, Michael PW. Grocott, Mark R. Edwards Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky Robert Sanders, Finton Hughes, Angela Bader, Annemarie Thompson, Andreas Hoeft, David Williams, Andrew D. Shaw Daniel I. Sessler, Sol Aronson, Colin Berry, Tong J. Gan, John Kellum, James Plumb, Joshua Bloomstone Matthew D. McEvoy, Julie K.M. Thacker, Ruchir Gupta, Elena Koepke, Aarne Feldheiser, Denny Levett, Frederic Michard, Mark Hamilton  British Journal of Anaesthesia  Volume 122, Issue 5, Pages (May 2019) DOI: /j.bja Copyright © 2019 British Journal of Anaesthesia Terms and Conditions

2 Fig 1 Relationship between the lowest cumulative absolute mean arterial pressure (MAP) maintained for 3 and 10 min and myocardial injury (left). Relationship between the lowest cumulative relative MAP maintained for 3 and 10 min and myocardial injury (right). Both were highly predictive, but relative thresholds were not more predictive than absolute thresholds which are easier to use. The relationships were generally similar for acute kidney injury (not shown). MINS, myocardial injury after non-cardiac surgery. Reproduced with permission from Salmasi and colleagues.17 British Journal of Anaesthesia  , DOI: ( /j.bja ) Copyright © 2019 British Journal of Anaesthesia Terms and Conditions

3 Fig 2 Relationship between average and lowest intraoperative mean arterila pressure (MAP) and 30 day postoperative mortality. High average or minimum MAP had relatively little effect on mortality. Note that the Y axis is logit; therefore, the increase in mortality from 80 to 40 mm Hg was more than six times greater than the small increase from 80 to 120 mm Hg. TWA, time-weighted average. Reproduced with permission from Mascha and colleagues.13 British Journal of Anaesthesia  , DOI: ( /j.bja ) Copyright © 2019 British Journal of Anaesthesia Terms and Conditions

4 Fig 3 (a) Predicted association of mean duration per incursion (min) below the threshold 95 mm Hg and 30 day mortality in the combined sample (n=7504). Shaded area represents the 95% confidence intervals for the predicted values. (b) Predicted association of mean duration per incursion (min) above the threshold 130 mm Hg and 30 day mortality in the combined sample (n=7504). Shaded area represents the 95% confidence intervals for the predicted values. Reproduced with permission from Aronson and colleagues.35 British Journal of Anaesthesia  , DOI: ( /j.bja ) Copyright © 2019 British Journal of Anaesthesia Terms and Conditions


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