BJA open最新文献

{"title":"Evaluation of lung homogeneity in neonates and small infants during general anaesthesia using electrical impedance tomography: a prospective observational study","authors":"Vanessa Marchesini ,&nbsp;Sebastian Corlette ,&nbsp;Suzette Sheppard ,&nbsp;Andrew Davidson ,&nbsp;David Tingay","doi":"10.1016/j.bjao.2024.100344","DOIUrl":"10.1016/j.bjao.2024.100344","url":null,"abstract":"<div><h3>Background</h3><p>Prolonged mechanical ventilation can create heterogeneous ventilation patterns, which increase the risk of lung injury in infants. However, little is understood about the risk of brief exposure to mechanical ventilation during anaesthesia. The aim of this prospective observational study was to describe the regional pattern of lung ventilation during general anaesthesia in healthy neonates and infants, using electrical impedance tomography.</p></div><div><h3>Methods</h3><p>Twenty infants (age 3 days to 12 months), without known lung disease and receiving general anaesthesia with endotracheal intubation for supine positioned surgery, were included in the study. Anaesthesia and ventilation management was at the discretion of the treating clinician. Standardised lung imaging using electrical impedance tomography was made at six time points during anaesthesia from induction to post-extubation. At each time point, the gravity-dependent and right–left lung centre of ventilation was calculated.</p></div><div><h3>Results</h3><p>Tidal ventilation favoured the dorsal lung regions at induction, with a median (inter-quartile range) centre of ventilation (CoV) of 58.2 (53.9–59.3)%. After intubation, there was a redistribution of ventilation to the ventral lung, with the greatest change occurring early in surgery: CoV of 53.8 (52.3–55.2)%. After extubation, CoV returned to pre-intubation values: 56.5 (54.7–58)%. Across all time points, the pattern of ventilation favoured the right lung.</p></div><div><h3>Conclusions</h3><p>General anaesthesia creates heterogenous patterns of ventilation similar to those reported during prolonged mechanical ventilation. This potentially poses a risk for lung injury that may not be recognised clinically. These results suggest the need to better understand the impact of general anaesthesia on the developing lung.</p></div><div><h3>Clinical trial registration</h3><p>Australian New Zealand Clinical Trials Registry (ACTRN 12616000818437, 22 June 2016).</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100344"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000881/pdfft?md5=c0680283a94d462b976090bbbaf78733&pid=1-s2.0-S2772609624000881-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric perioperative hypersensitivity: the performance of the current consensus formula and the effect of uneventful anaesthesia on serum tryptase. Reply to BJA Open 2024; 9: 100254","authors":"Nils Vlaeminck ,&nbsp;Marie-Line van der Poorten ,&nbsp;Vera Saldien ,&nbsp;Vito Sabato ,&nbsp;Didier G. Ebo","doi":"10.1016/j.bjao.2024.100308","DOIUrl":"10.1016/j.bjao.2024.100308","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100308"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000522/pdfft?md5=c4654bf9de9875d669e57f92c03b2feb&pid=1-s2.0-S2772609624000522-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An update on iron therapy as an intervention to reduce blood transfusion for patients undergoing hip fracture surgery","authors":"Beth MacLean,&nbsp;Jayne Lim,&nbsp;Toby Richards","doi":"10.1016/j.bjao.2024.100311","DOIUrl":"10.1016/j.bjao.2024.100311","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000558/pdfft?md5=305ae27cefa154f392c56e8fb38e60ac&pid=1-s2.0-S2772609624000558-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum tryptase changes in children with suspected perioperative hypersensitivity. Comment on BJA Open 2024; 9: 100254","authors":"S. Green ,&nbsp;B. Krupowicz ,&nbsp;M. Capon ,&nbsp;A. Lindberg ,&nbsp;A. Kulkarni ,&nbsp;J. Li","doi":"10.1016/j.bjao.2024.100307","DOIUrl":"10.1016/j.bjao.2024.100307","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100307"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000510/pdfft?md5=e55333ba636abad16afc694c71a61c5b&pid=1-s2.0-S2772609624000510-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of neuromodulation for chronic pain on the autonomic nervous system: a systematic review","authors":"Bart Billet ,&nbsp;Lisa Goudman ,&nbsp;Philippe Rigoard ,&nbsp;Maxime Billot ,&nbsp;Manuel Roulaud ,&nbsp;Sören Verstraete ,&nbsp;Werner Nagels ,&nbsp;Maarten Moens","doi":"10.1016/j.bjao.2024.100305","DOIUrl":"10.1016/j.bjao.2024.100305","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;In recent years, there has been a growing interest in the use of neuromodulation as an alternative treatment option for chronic pain. Neuromodulation techniques, such as spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation, deep brain stimulation (DBS), and peripheral nerve stimulation, have shown promising results in the management of various chronic pain conditions and involve targeted modulation of neural activity to alleviate pain and restore functional capacity. The autonomic nervous system (ANS) plays a crucial role in the regulation of various bodily functions including pain perception. However, the effects of neuromodulation on the ANS in the context of chronic pain remain poorly understood. This systematic review aimed to comprehensively assess the existing literature about the effects of neuromodulation on the ANS in chronic pain settings.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Searches were conducted using four electronic databases (PubMed, EMBASE, SCOPUS, and Web of Science). The study protocol was registered before initiation of the review process. The Office of Health Assessment and Translation (OHAT) Risk of Bias tool was used to evaluate risk of bias.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 43 studies were included, of which only one was an animal study. Several studies have reported more than one outcome parameter in the same population of chronic pain patients. Cardiovascular parameters were the most frequently used outcomes. More specifically, 18 outcome parameters were revealed to evaluate the function of the ANS, namely heart rate variability (&lt;em&gt;n&lt;/em&gt;=17), arterial blood pressure (&lt;em&gt;n&lt;/em&gt;=15), tissue oxygenation/perfusion (&lt;em&gt;n&lt;/em&gt;=5), blood markers (&lt;em&gt;n&lt;/em&gt;=6), multiunit postganglionic sympathetic nerve activity (&lt;em&gt;n&lt;/em&gt;=4), skin temperature (&lt;em&gt;n&lt;/em&gt;=3), skin conductance (&lt;em&gt;n&lt;/em&gt;=3), cephalic autonomic symptoms (&lt;em&gt;n&lt;/em&gt;=2), ventilatory frequency (&lt;em&gt;n&lt;/em&gt;=2), vasomotor tone (&lt;em&gt;n&lt;/em&gt;=1), baroreflex sensitivity (&lt;em&gt;n&lt;/em&gt;=1), sympathetic innervation of the heart, neural activity of intrinsic cardiac neurons (&lt;em&gt;n&lt;/em&gt;=1), vascular conductance (&lt;em&gt;n&lt;/em&gt;=1), arterial diameter (&lt;em&gt;n&lt;/em&gt;=1), blood pulse volume (&lt;em&gt;n&lt;/em&gt;=1), and vagal efficiency (&lt;em&gt;n&lt;/em&gt;=1). Most studies evaluated SCS (62.79%), followed by DBS (18.6%), peripheral nerve stimulation (9.3%), DRG stimulation (4.65%), and vagus nerve stimulation (4.65%). Overall, inconsistent results were revealed towards contribution of SCS, DBS, and peripheral nerve stimulation on ANS parameters. For DRG stimulation, included studies pointed towards a decrease in sympathetic activity.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;There are indications that neuromodulation alters the ANS, supported by high or moderate confidence in the body of evidence, however, heterogeneity in ANS outcome measures drives towards inconclusive results. Further research is warranted to elucidate the indirect or direct mechanisms of ","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"11 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000492/pdfft?md5=20ae858320b29e303cd0fa605709276a&pid=1-s2.0-S2772609624000492-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variable positive end-expiratory pressure in an experimental model of acute respiratory distress syndrome: an advanced ventilation modality","authors":"Roberta Südy ,&nbsp;John Diaper ,&nbsp;Davide Bizzotto ,&nbsp;Rafaelle Dellàca ,&nbsp;Ferenc Petak ,&nbsp;Walid Habre ,&nbsp;Andre Dos Santos Rocha","doi":"10.1016/j.bjao.2024.100302","DOIUrl":"10.1016/j.bjao.2024.100302","url":null,"abstract":"<div><h3>Background</h3><p>Introducing variability in tidal volume, ventilatory frequency, or both is beneficial during mechanical ventilation in acute respiratory distress syndrome (ARDS). We investigated whether applying cycle-by-cycle variability in the positive end-expiratory pressure (PEEP) exerts beneficial effect on lung function in a model of ARDS.</p></div><div><h3>Methods</h3><p>Rabbits with lung injury were randomly allocated to receive mechanical ventilation for 6 h by applying a pressure-controlled mode with constant PEEP of 7 cm H₂O (PC group: <em>n</em>=6) or variable PEEP (VEEP) with a coefficient of variation of 21.4%, range 4–10 cm H₂O (PC-VEEP group; <em>n</em>=6). Lung oxygenation index (<em>P</em>a<span>o</span>₂/FiO₂) after 6 h of ventilation (H6) was the primary outcome and respiratory mechanics, lung volume, intrapulmonary shunt, and lung inflammatory markers were secondary outcomes.</p></div><div><h3>Results</h3><p>After lung injury, both groups presented moderate-to-severe ARDS (<em>P</em>a<span>o</span>₂/FiO₂ &lt;27 kPa). The <em>P</em>a<span>o</span>₂/FiO₂ was significantly higher in the PC-VEEP group than in the PC group at H6 (12.3 [<span>sd</span> 3.5] <em>vs</em> 19.2 [7.2] kPa, <em>P</em>=0.013) and a lower arterial partial pressure of CO₂ at 1–3 h (<em>P</em>&lt;0.02). The ventilation-induced increases in airway resistance and tissue elastance were prevented by PC-VEEP. There was no evidence for a difference in minute volume, driving pressure, end-tidal CO₂, lung volumes, intrapulmonary shunt fraction, and cytokines between the ventilation modes.</p></div><div><h3>Conclusions</h3><p>Prolonged mechanical ventilation with cycle-by-cycle VEEP prevents deterioration in gas exchange and respiratory mechanics in a model of ARDS, suggesting the benefit of this novel ventilation strategy to optimise gas exchange without increasing driving pressure and lung overdistension.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"11 ","pages":"Article 100302"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000467/pdfft?md5=bb75ea3ad3c8a7e3b54a06862b85ba1d&pid=1-s2.0-S2772609624000467-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141985402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Delirium Pathophysiology & Electrophysiology Network for Data sharing (iDEPEND)","authors":"Robert D. Sanders ,&nbsp;Leiv Watne ,&nbsp;Shawniqua Williams Roberson ,&nbsp;Eyal Y. Kimchi ,&nbsp;Arjen J.C. Slooter ,&nbsp;Colm Cunningham ,&nbsp;Kirill V. Nourski ,&nbsp;Ben J.A. Palanca ,&nbsp;Richard Lennertz ,&nbsp;Matthew I. Banks","doi":"10.1016/j.bjao.2024.100304","DOIUrl":"10.1016/j.bjao.2024.100304","url":null,"abstract":"<div><p>In an era of ‘big data’, we propose that a collaborative network approach will drive a better understanding of the mechanisms of delirium, and more rapid development of therapies. We have formed the International Delirium Pathophysiology &amp; Electrophysiology Network for Data sharing (iDEPEND) group with a key aim to ‘facilitate the study of delirium pathogenesis with electrophysiology, imaging, and biomarkers including data acquisition, analysis, and interpretation’. Our initial focus is on studies of electrophysiology as we anticipate this methodology has great potential to enhance our understanding of delirium. Our article describes this principle and is used to highlight the endeavour to the wider community as we establish key stakeholders and partnerships.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"11 ","pages":"Article 100304"},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000480/pdfft?md5=f38de960f93fc7356b70bf01f677be3c&pid=1-s2.0-S2772609624000480-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative intravenous iron to treat iron-deficiency anaemia in patients undergoing cardiac surgery: a protocol for a pilot, multicentre, placebo-controlled randomized trial (the POAM trial)","authors":"Justyna Bartoszko ,&nbsp;Sarah Miles ,&nbsp;Saba Ansari ,&nbsp;Deep Grewal ,&nbsp;Michelle Li ,&nbsp;Jeannie Callum ,&nbsp;Stuart A. McCluskey ,&nbsp;Yulia Lin ,&nbsp;Keyvan Karkouti","doi":"10.1016/j.bjao.2024.100303","DOIUrl":"10.1016/j.bjao.2024.100303","url":null,"abstract":"<div><h3>Background</h3><p>Iron-deficiency anaemia, occurring in 30–40% of patients undergoing cardiac surgery, is an independent risk factor for adverse outcomes. Our long-term goal is to assess if postoperative i.v. iron therapy improves clinical outcomes in patients with preoperative iron-deficiency anaemia undergoing cardiac surgery. Before conducting a definitive RCT, we first propose a multicentre pilot trial to establish the feasibility of the definitive trial.</p></div><div><h3>Methods</h3><p>This internal pilot, double-blinded, RCT will include three centres. Sixty adults with preoperative iron-deficiency anaemia undergoing non-emergency cardiac surgery will be randomised on postoperative day 2 or 3 to receive either blinded i.v. iron (1000 mg ferric derisomaltose) or placebo. Six weeks after surgery, patients who remain iron deficient will receive a second blinded dose of i.v. iron according to their assigned treatment arm. Patients will be followed for 12 months. Clinical practice will not be otherwise modified. For the pilot study, feasibility will be assessed through rates of enrolment, protocol deviations, and loss to follow up. For the definitive study, the primary outcome will be the number of days alive and out of hospital at 90 days after surgery.</p></div><div><h3>Ethics and dissemination</h3><p>The trial has been approved by the University Health Network Research Ethics Board (REB # 22-5685; approved by Clinical Trials Ontario funding on 22 December 2023) and will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practices guidelines, and regulatory requirements.</p></div><div><h3>Clinical trial registration</h3><p>NCT06287619.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"11 ","pages":"Article 100303"},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000479/pdfft?md5=d58c47a1c668bf884171cd664f423875&pid=1-s2.0-S2772609624000479-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operating table stability and patient safety during an earthquake based on the results of a shaking table experiment","authors":"Takahiko Tsutsumi ,&nbsp;Keita Fukuyama ,&nbsp;Kazumasa Kishimoto ,&nbsp;Yukiko Mori ,&nbsp;Osamu Sugiyama ,&nbsp;Goshiro Yamamoto ,&nbsp;Masahiro Kurata ,&nbsp;Ueshima Hiroaki ,&nbsp;Kenichi Saito ,&nbsp;Tomohiro Kuroda ,&nbsp;Shigeru Ohtsuru","doi":"10.1016/j.bjao.2024.100301","DOIUrl":"10.1016/j.bjao.2024.100301","url":null,"abstract":"<div><h3>Background</h3><p>The damage that may be caused to the operating table and patients under general anaesthesia when a large earthquake occurs is unclear. We aimed to evaluate the movement and damage to operating tables and patients under general anaesthesia during an earthquake.</p></div><div><h3>Methods</h3><p>An operating table with a manikin resembling a patient on it was placed on a shaking table, and seismic waves were input into the shaking table. The effects of seismic waves were evaluated by altering surgical positions (supine and head-down positions), operating tables, flooring material, seismic waves, and output. We observed the movement of the operating table and measured the acceleration of the operating table and manikin head.</p></div><div><h3>Results</h3><p>Under 90% output of long-period seismic waves, the operating table with the supine manikin was overturned. Under experimental conditions that did not cause rocking, shaking such as tilting of the operating table caused stronger acceleration in the manikin's head than in the operating table. There was no clear relationship between operating table rocking and maximum acceleration as a result of programmed seismic waves. In long-period earthquakes, rocking and overturning occurred &gt;60 s after the onset of shaking, whereas in direct earthquakes, rocking occurred within 10 s.</p></div><div><h3>Conclusions</h3><p>An earthquake could cause strong acceleration of the patient's head under general anaesthesia, and operating tables may overturn or shake violently. Regarding patient safety, further measures to prevent overturning should be considered.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"11 ","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000455/pdfft?md5=fa1ddc34d5f768d4844c3e073dd76060&pid=1-s2.0-S2772609624000455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141622767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalised blood pressure management during major noncardiac surgery and postoperative neurocognitive disorders: a randomised trial","authors":"Julia Y. Nicklas ,&nbsp;Alina Bergholz ,&nbsp;Francesco Däke ,&nbsp;Hanh H.D. Pham ,&nbsp;Marie-Christin Rabe ,&nbsp;Hanna Schlichting ,&nbsp;Sophia Skrovanek ,&nbsp;Moritz Flick ,&nbsp;Karim Kouz ,&nbsp;Marlene Fischer ,&nbsp;Cynthia Olotu ,&nbsp;Jakob R. Izbicki ,&nbsp;Oliver Mann ,&nbsp;Margit Fisch ,&nbsp;Barbara Schmalfeldt ,&nbsp;Karl-Heinz Frosch ,&nbsp;Thomas Renné ,&nbsp;Linda Krause ,&nbsp;Christian Zöllner ,&nbsp;Bernd Saugel","doi":"10.1016/j.bjao.2024.100294","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100294","url":null,"abstract":"<div><h3>Background</h3><p>It remains unknown whether there is a causal relationship between intraoperative hypotension and postoperative neurocognitive disorders. We tested the hypothesis that personalised—compared to routine—intraoperative blood pressure management reduces the incidence of postoperative neurocognitive disorders in patients having major noncardiac surgery.</p></div><div><h3>Methods</h3><p>In this single-centre trial, 328 elective major noncardiac surgery patients were randomly allocated to receive personalised blood pressure management (i.e. maintaining intraoperative mean arterial pressure [MAP] above preoperative baseline MAP from automated 24-h blood pressure monitoring) or routine blood pressure management (i.e. maintaining MAP above 65 mm Hg). The primary outcome was the incidence of neurocognitive disorders (composite of delayed neurocognitive recovery and delirium) between postoperative days 3 and 7.</p></div><div><h3>Results</h3><p>The primary outcome, neurocognitive disorders, occurred in 18 of 147 patients (12%) assigned to personalised and 21 of 148 patients (14%) assigned to routine blood pressure management (odds ratio [OR]=0.84, 95% confidence interval [CI]: 0.40–1.75, <em>P</em>=0.622). Delayed neurocognitive recovery occurred in 17 of 146 patients (12%) assigned to personalised and 17 of 145 patients (12%) assigned to routine blood pressure management (OR=0.99, 95% CI: 0.45–2.17, <em>P</em>=0.983). Delirium occurred in 2 of 157 patients (1%) assigned to personalised and 4 of 158 patients (3%) assigned to routine blood pressure management (OR=0.50, 95% CI: 0.04–3.53, <em>P</em>=0.684).</p></div><div><h3>Conclusions</h3><p>Personalised intraoperative blood pressure management maintaining preoperative baseline MAP neither reduced the incidence of the composite primary outcome neurocognitive disorders between postoperative days 3 and 7 nor the incidences of the components of the composite primary outcome—delayed neurocognitive recovery and delirium—compared to routine blood pressure management in patients having major noncardiac surgery.</p></div><div><h3>Clinical trial registration</h3><p>ClinicalTrials.gov (NCT03442907).</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"11 ","pages":"Article 100294"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000388/pdfft?md5=9bf430a1b6ab4396283951ce3a7e2b68&pid=1-s2.0-S2772609624000388-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141487223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}