Under pressure: Keep MAP > 65 mm Hg or within 20% of baseline?-Slide Deck - Under pressure: Keep MAP

Slide Deck - Under pressure: Keep MAP > 65 mm Hg or within 20% of baseline?

Pdf Summary

This document discusses the management of intraoperative hypotension (IOH), emphasizing whether to maintain mean arterial pressure (MAP) at a threshold of 65 mmHg or within 20% of a patient's baseline, to prevent adverse outcomes such as acute kidney injury and myocardial injury. The presentation by Desiree Chappell and Amy Yerdon, who have disclosed their financial relationships with Edwards Lifesciences, addresses limitations of using intraoperative threshold values relative to preoperative blood pressure and supports the utility of maintaining an absolute MAP threshold to minimize complications.<br /><br />Key findings highlight the importance of continuous blood pressure monitoring to adjust MAP dynamically and reduce hemodynamic instability. The potential dangers of even brief periods of hypotension (MAP below 65 mmHg) during surgery are underscored, particularly in the context of increased risk of organ injury and mortality. Studies cited indicate that personalized intraoperative blood pressure management did not statistically differ in outcomes compared to standard management, indicating the importance of maintaining a consistent MAP rather than adjusting according to preoperative metrics alone.<br /><br />Moreover, the document encourages the implementation of continuous monitoring techniques over intermittent methods to achieve better control of blood pressure during procedures. Research has demonstrated improved outcomes and reduced rates of hypotension when continuous intra-arterial monitoring was used from induction through the procedure.<br /><br />The use of vasoactive medications and optimizing fluid status are proposed strategies to ensure blood pressure stability. Overall, the document advocates for consensus guidelines that emphasize the critical importance of maintaining a MAP of no less than 65 mmHg, coupled with continuous blood pressure monitoring, to enhance patient safety during anesthesia. The authors express the need for widespread adoption of these practices as core competencies in perioperative care to prevent IOH and the associated negative outcomes.

Keywords

intraoperative hypotension

mean arterial pressure

acute kidney injury

myocardial injury

blood pressure monitoring

hemodynamic instability

continuous monitoring

vasoactive medications

perioperative care

patient safety