Proactive vs Reactive Treatment of Hypotension During Surgery

Does intraoperative blood pressure management with a mean arterial pressure goal stratified by preoperatively determined risk of intraoperative hypotension improve postoperative functional disability at 6 months in patients undergoing elective noncardiac surgery?In this randomized clinical trial including 3247 adults undergoing elective noncardiac surgery, targeting a mean atrial pressure of at least 70 mm Hg for patients at low risk, at least 80 mm Hg for those at intermediate risk, and at least 90 mm Hg for those at high risk of intraoperative hypotension did not improve postoperative disability at 6 months as measured by the World Health Organization Disability Assessment Schedule (range, 0 to 100; minimal clinically important difference, 5 percentage points) compared with usual intraoperative management that aimed to maintain a mean arterial pressure of at least 65 mm Hg at the discretion of the treating anesthesiologist (mean score, 17.7 vs 18.2, respectively).Proactive, risk-stratified blood pressure management did not improve postoperative disability at 6 months.

Corresponding Author: Matthijs Kant, MD, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands (m.kant-2@umcutrecht.nl).

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