Continuous noninvasive monitoring revealed that 47% of hypotensive and 96% of severe hypertensive episodes were undetected by routine vital-sign assessments in adults after abdominal surgery.
Cohort (n=312)
Single-blind
Does continuous noninvasive blood pressure monitoring detect more postoperative hemodynamic perturbations compared to routine vital-sign assessments in adults recovering from abdominal surgery?
Continuous noninvasive blood pressure monitoring detects significantly more prolonged and profound postoperative hemodynamic perturbations than routine vital-sign assessments in adults recovering from abdominal surgery.
BACKGROUND: Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality. Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured only every 4 to 6 h, leaving long intervals during which hypotension and hypertension may be undetected. This study evaluated the incidence and severity of postoperative hypotension and hypertension in adults recovering from abdominal surgery and the extent to which serious perturbations were missed by routine vital-sign assessments. METHODS: Blood pressure was recorded at 1-min intervals during the initial 48 h in adults recovering from abdominal surgery using a continuous noninvasive monitor. Caregivers were blinded to these measurements and depended on routine vital-sign assessments. Hypotension and hypertension were characterized as time under and above various mean arterial pressure thresholds. RESULTS: Of 502 available patients, 312 patients with high-quality records were analyzed, with a median measurement time of 48 interquartile range: 41, 48 postoperative hours. Nearly a quarter experienced an episode of mean arterial pressure of less than 70 mm Hg lasting at least 30 min (24%; 95% CI, 20%, 29%), and 18% had an episode of mean arterial pressure of less than 65 mm Hg lasting at least 15 min. Nearly half the patients who had mean arterial pressure of less than 65 mm Hg for at least 15 min (47%; 95% CI, 34%, 61%) were undetected by routine vital-sign assessments. Episodes of mean arterial pressure greater than 110 mm Hg lasting at least 30 min were observed in 42% (95% CI, 37%, 48%) of patients; 7% had mean arterial pressure greater than 130 mm Hg for at least 30 min, 96% of which were missed by routine assessments. Episodes of mean arterial pressure less than 65 mm Hg and mean arterial pressure greater than 110 mm Hg captured by routine vital-sign assessments but not by continuous monitoring occurred in 34 and 8 patients, respectively. CONCLUSIONS: Postoperative hypotension and hypertension were common, prolonged, profound, and largely undetected by routine vital-sign assessments in a cohort of adults recovering from abdominal surgery. Frequent or continuous blood pressure monitoring may detect hemodynamic perturbations more effectively and potentially facilitate treatment.
Turan et al. (Tue,) conducted a cohort in Postoperative recovery from abdominal surgery (n=312). Continuous noninvasive blood pressure monitoring vs. Routine vital-sign assessments was evaluated on Incidence of mean arterial pressure less than 70 mm Hg lasting at least 30 min (95% CI 20-29). Continuous noninvasive monitoring revealed that 47% of hypotensive and 96% of severe hypertensive episodes were undetected by routine vital-sign assessments in adults after abdominal surgery.
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