Key result
Automated closed-loop vasopressor systems limit intraoperative hypotension to ~2% of case time.
Why the study?
Little is known about the performance metrics of automated closed-loop vasopressor infusions when systolic arterial pressure is the controlled variable rather than mean arterial pressure.
Does a closed-loop vasopressor system targeting systolic arterial pressure prevent intraoperative hypotension in patients undergoing intermediate- to high-risk abdominal surgery?
Cohort (n=12)
No
Does a closed-loop vasopressor system targeting systolic arterial pressure prevent intraoperative hypotension in patients undergoing intermediate- to high-risk abdominal surgery?
A closed-loop vasopressor system targeting systolic arterial pressure is feasible and maintains blood pressure within target range for >90% of intraoperative time during high-risk abdominal surgery.
Supports feasibility in high-risk abdominal surgery; leaves open outcome benefits pending randomized trials.
Introduction: Vasopressor infusions are essential in treating and preventing intraoperative hypotension. Closed-loop vasopressor therapy outperforms clinicians when the target is set at a mean arterial pressure (MAP) baseline, but little is known on the performance metrics of closed-loop vasopressor infusions when systolic arterial pressure (SAP) is the controlled variable. Methods: Patients undergoing intermediate- to high-risk abdominal surgery were included in this prospective cohort feasibility study. All patients received norepinephrine infusion through a computer controlled closed-loop system that targeted SAP at 130 mmHg. The primary objective was to determine the percent of case time in hypotension or under target defined as SAP below 10% of the target (SAP < 117 mmHg). Secondary objectives were the percent of case time “above target” (SAP > 10% of the target or >143 mmHg) and “in target” (within 10% of the SAP target or SAP between 117 and 143 mmHg). Results: A total of 12 patients were included. The closed-loop system infused norepinephrine for a median of 94.6% (25−75th percentile: 90.0−98.0%) of case time. The percentage of case time in hypotension or under target was only 1.8% (0.9−3.6%). The percentages of case time “above target” and “in target” were 4.7% (3.2−7.5%) and 92.4% (90.1−96.3%), respectively. Conclusions: This closed-loop vasopressor system minimizes intraoperative hypotension and maintains SAP within 10% of the target range for >90% of the case time in patients undergoing intermediate- to high-risk abdominal surgery.
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Rinehart et al. (2022) conducted a cohort in Intermediate- to high-risk abdominal surgery (n=12). Automated closed-loop vasopressor (CLV) system was evaluated on Percentage of case time in hypotension or under target (systolic arterial pressure < 117 mmHg). An automated closed-loop vasopressor system minimized intraoperative hypotension, with patients spending a median of only 1.8% of case time with a systolic arterial pressure below 117 mmHg.
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