A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study
Background: Postinduction hypotension is common and associated with organ injury but might be largely preventable by careful anaesthetic management. We thus aimed to quantify the severity and duration of postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension pr...
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Elsevier
2025-06-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772609625000164 |
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| author | Kristen K. Thomsen Alina Kröker Linda Krause Karim Kouz Christian Zöllner Daniel I. Sessler Bernd Saugel Moritz Flick |
| author_facet | Kristen K. Thomsen Alina Kröker Linda Krause Karim Kouz Christian Zöllner Daniel I. Sessler Bernd Saugel Moritz Flick |
| author_sort | Kristen K. Thomsen |
| collection | DOAJ |
| description | Background: Postinduction hypotension is common and associated with organ injury but might be largely preventable by careful anaesthetic management. We thus aimed to quantify the severity and duration of postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension prevention bundle. Methods: In this prospective single-arm interventional proof-of-concept study, 107 high-risk noncardiac surgery patients were treated with a hypotension prevention bundle. The bundle included continuous intra-arterial blood pressure monitoring, a hypotension alarm set at a mean arterial pressure (MAP) of 75 mm Hg, careful administration of anaesthetic drugs, and continuous administration of norepinephrine when MAP decreased below 75 mm Hg. The primary endpoint, AUC65, was derived from a plot of MAP over time for the first 15 min after induction of general anaesthesia as the area of the plot under a MAP of 65 mm Hg . Results: Of 107 patients, 55 (51%) had at least one MAP reading <65 mm Hg, but only 16/107 patients (15%) had a MAP <65 mm Hg for at least one continuous minute. Patients had a MAP <65 mm Hg for a median (25% percentile, 75% percentile; minimum–maximum) of 0.2 min (0.0, 0.8; 0.0–5.2 min). The median AUC65 was 0.1 mm Hg . min (0.0, 4.1; 0.0–40.6 mm Hg min). Conclusions: We observed minimal postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension prevention bundle. However, randomised trials are needed to confirm that using the hypotension prevention bundle helps reduce postinduction hypotension. |
| format | Article |
| id | doaj-art-e8d7a214efdd40d9a9b71be3dc4533fe |
| institution | DOAJ |
| issn | 2772-6096 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | BJA Open |
| spelling | doaj-art-e8d7a214efdd40d9a9b71be3dc4533fe2025-08-20T03:03:38ZengElsevierBJA Open2772-60962025-06-011410039210.1016/j.bjao.2025.100392A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept studyKristen K. Thomsen0Alina Kröker1Linda Krause2Karim Kouz3Christian Zöllner4Daniel I. Sessler5Bernd Saugel6Moritz Flick7Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium®, Houston, TX, USA; Corresponding author. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyInstitute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium®, Houston, TX, USADepartment of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyOutcomes Research Consortium®, Houston, TX, USA; Department of Anesthesiology and Center for Outcomes Research, University of Texas Health Science Center, Houston, TX, USADepartment of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium®, Houston, TX, USADepartment of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyBackground: Postinduction hypotension is common and associated with organ injury but might be largely preventable by careful anaesthetic management. We thus aimed to quantify the severity and duration of postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension prevention bundle. Methods: In this prospective single-arm interventional proof-of-concept study, 107 high-risk noncardiac surgery patients were treated with a hypotension prevention bundle. The bundle included continuous intra-arterial blood pressure monitoring, a hypotension alarm set at a mean arterial pressure (MAP) of 75 mm Hg, careful administration of anaesthetic drugs, and continuous administration of norepinephrine when MAP decreased below 75 mm Hg. The primary endpoint, AUC65, was derived from a plot of MAP over time for the first 15 min after induction of general anaesthesia as the area of the plot under a MAP of 65 mm Hg . Results: Of 107 patients, 55 (51%) had at least one MAP reading <65 mm Hg, but only 16/107 patients (15%) had a MAP <65 mm Hg for at least one continuous minute. Patients had a MAP <65 mm Hg for a median (25% percentile, 75% percentile; minimum–maximum) of 0.2 min (0.0, 0.8; 0.0–5.2 min). The median AUC65 was 0.1 mm Hg . min (0.0, 4.1; 0.0–40.6 mm Hg min). Conclusions: We observed minimal postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension prevention bundle. However, randomised trials are needed to confirm that using the hypotension prevention bundle helps reduce postinduction hypotension.http://www.sciencedirect.com/science/article/pii/S2772609625000164anaesthesia inductionarterial catheterblood pressuregeneral anaesthesiahaemodynamic monitoringhypotension alarm |
| spellingShingle | Kristen K. Thomsen Alina Kröker Linda Krause Karim Kouz Christian Zöllner Daniel I. Sessler Bernd Saugel Moritz Flick A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study BJA Open anaesthesia induction arterial catheter blood pressure general anaesthesia haemodynamic monitoring hypotension alarm |
| title | A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study |
| title_full | A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study |
| title_fullStr | A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study |
| title_full_unstemmed | A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study |
| title_short | A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study |
| title_sort | bundle to prevent postinduction hypotension in high risk noncardiac surgery patients the zero hypotension single arm interventional proof of concept study |
| topic | anaesthesia induction arterial catheter blood pressure general anaesthesia haemodynamic monitoring hypotension alarm |
| url | http://www.sciencedirect.com/science/article/pii/S2772609625000164 |
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