Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial
Hypothesis: Targeting individualized blood pressure, tailored to the patient’s usual value, will reduce organ dysfunction as compared with standard practice
Methods: Multi-center RCT of 298 patients at increased risk of perioperative complications. Subjects were randomized to an individualized BP group (SBP within 10% of their resting SBP) or standard management group (SBP greater than 80 mm Hg or within 40% from their reference value) during and for 4 hours following surgery.
Results: The primary outcome (a composite of SIRS and dysfunction of 1 organ system) occurred in 38.1% of subjects in the individualized group vs 51.7% of subjects in the standard treatment group (relative risk, 0.73; 95% CI, 0.56 to 0.94).
Weaknesses: Treatment for hypotension differed between groups (phenylephrine vs. ephedrine), duration of hypotension not recorded, use of hextend limits external generalizability
Key Point: An individualized perioperative BP management strategy may reduce postop complications.