. 2024 Apr 1;138(4):713-724.

doi: 10.1213/ANE.0000000000006789. Epub 2023 Dec 28.

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation

Michael J Scott^{1

2

3}; APSF Hemodynamic Instability Writing Group

Collaborators, Affiliations

Collaborators

APSF Hemodynamic Instability Writing Group:
Michael Scott⁴, Alparslan Turan⁵, Shane Angus⁶, Maxime Cannesson⁷, Daniel J Cole⁸, Deborah Culley⁹, Elizabeth Duggan¹⁰, Richard P Dutton¹¹, Jeffrey Feldman¹², Mike P W Grocott¹³, Oliver Huet¹⁴, Anne Huffenberger¹⁵, Allison M Janda¹⁶, Ashish K Khanna¹⁷, Clifford Ko¹⁸, Christina Matadial¹⁹, Matthew D McEvoy²⁰, Nirav Shah²¹, Joseph Szokol²², Louise Y Sun²³

Affiliations

¹ From the Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
² Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
³ Department of Anesthesia Critical Care and Pain Medicine, University College London, London, United Kingdom.
⁴ Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
⁵ Department of Anesthesiology & Department of Outcomes Research, Cleveland Clinic, OH. Editor-in-Chief, Journal of clinical Anesthesia. This author contributed to the discussion and data acquisition, and revision and final approval of the article. Dr Alparslan Tarun served as a consultant for CIVCO.
⁶ Department of Anesthesiology, Center for Medical Education, Case Western Reserve University, School of Medicine, Washington, DC. This author contributed to attending the conference, developing data acquisition methodology, interpretation of results, revision of the article, and final approval of the article. S. Angus has been a member of the Board of Directors for the Anesthesia Patient Safety Foundation.
⁷ Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California. This author contributed to performing a speech at the conference where the material in this article was generated, contributed to discussion and data acquisition, and contributed to writing, revision, and final approval of the article. M. Cannesson is a consultant for Edwards Lifesciences and Masimo Corp, and has funded research from Edwards Lifesciences and Masimo Corp. He is also the founder of Sironis and Perceptive Medical and he owns patents and receives royalties for closed-loop hemodynamic management technologies that have been licensed to Edwards Lifesciences. He received a grant from NIH R01EB029751.
⁸ Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California. This author contributed to the conference planning committee, chairing the conference, developing data acquisition methodology, interpretation of results, writing and revision of the article, and final approval of the article. D. J. Cole is the president of the Anesthesia Patient Safety Foundation, which sponsored the conference.
⁹ Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. This author contributed to attending the conference, developing data acquisition methodology, interpretation of results, revision of the article, and final approval of the article. D. Culley is the Co-Editor-in-Chief of Anesthesiology.
¹⁰ Department of Anesthesia, University of Alabama, Birmingham, Alabama. This author contributed to performing a speech at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article.
¹¹ Chief Quality Officer, US Anesthesia Partners, Dallas, Texas. This author spoke at the conference where the material in this article was generated, acquired consensus data, interpreted the results, and wrote and reviewed the article.
¹² Department of Anesthesiology, Children's Hospital of Philadelphia, Perelman School of Medicine - University of Pennsylvania, Philadelphia, PA 19104. Chair, APSF Committee on Technology. This author attended the conference, developing data acquisition methodology, interpretation of results, revision of the article, and final approval of the article. J. Feldman is Chair of the APSF Committee on Technology.
¹³ Department of Anesthesia and Critical Care, Southampton General Hospital, Tremona Road Shirley, Southampton SO16 6YD, UK. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. M. P. W. Grocott is deputy chair of the UK Centre for Perioperative Care, an elected council member and trustee of the Royal College of Anaesthetists, board chair of the UK National Institute of Academic Anaesthesia and joint editor-in-chief of Perioperative Medicine. He is an NIHR senior investigator and director of the NIHR Southampton Biomedical Research Centre. He has served as a consultant for Sphere Medical Ltd, South-West Sensors Ltd and Edwards Lifesciences.
¹⁴ Département d'Anesthésie-Réanimation, et Médecine Péri-Opératoire, CHRU de Brest, Université de Bretagne Occidentale, Hôpital de la Cavale Blanche, Bd Tanguy Prigent, 29609 Brest, France. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. O. Huet has received an honorarium from Edwards Life Sciences and Fresenius Kabi and research funding from Baxter.
¹⁵ Director of Penn Center for Connected Care, Penn Medicine Rittenhouse Campus, Philadelphia, PA 19146. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article.
¹⁶ Assistant Professor, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. A. M. Janda has received research funding paid to the University of Michigan from the National Institute of General Medical Sciences and National Heart, Lung, and Blood Institute of the National Institutes of Health under award numbers T32GM103730 and K23HL166685.
¹⁷ Department of Anesthesiology, Section on Critical Care Medicine, Perioperative Outcomes and Informatics Collaborative, Atrium Health Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, NC. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. A. K. Khanna consults for Medtronic, Edwards Life Sciences, Philips Research North America, Baxter, GE Healthcare, Potrero Medical, Fifth Eye Inc., Renibus Therapeutics, Retia Medical, and Caretaker Medical. He is also funded with a Clinical and Translational Science Institute (CTSI) NIH/NCTAS KL2 TR001421 award for a trial on continuous postoperative hemodynamic and saturation monitoring. The Department of Anesthesiology at Wake Forest School of Medicine is supported by Edwards Lifesciences under a master clinical trials agreement.
¹⁸ Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California. Director of the Division of Research and Optimal Patient Care at the American College of Surgeons and Director of ACS NSQIP. This author contributed to structuring of the data acquisition, interpretation of the results, writing and revision of the article and final approval of the article. C. Ko is the director of the Division of Research and Optimal Patient Care at the American College of Surgeons, and director of American College of Surgeons NSQIP.
¹⁹ Associate Professor of Clinical Anesthesiology, University of Miami Miller School of Medicine, Department of Anesthesiology, Perioperative Medicine and Pain Management, Associate Professor of Anesthesiology, Florida International University, Herbert Wertheim College of Medicine, Park, Florida. This author attended the conference, developing data acquisition methodology, interpretation of results, writing and revision of the article, and final approval of article.
²⁰ Professor of Anesthesiology and Surgery, Vice-Chair of Perioperative Medicine, Medical Director, VUMC Enhanced Recovery Programs, Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC 4648, Nashville, TN 37232. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article.
²¹ Associate Professor, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. N. J. Shah has recently received research funding paid to the University of Michigan from the National Library of Medicine and National Institute of Aging of the National Institutes of Health, Blue Cross Blue Michigan, Patient-Centered Outcomes Research Institute, Edwards Lifesciences, and Apple, Inc.
²² Keck School of Medicine of USC, 1500 San Pablo St, Health Science Campus, Los Angeles, CA 90033. Chief Policy Officer, American Society of Anesthesiologists. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. J. Szokol is the chief policy officer at the American Society of Anesthesiologists.
²³ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Rm 3584B, Palo Alto, CA 94305. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article.

PMID: 38153876
PMCID: PMC10916753
DOI: 10.1213/ANE.0000000000006789

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation

Michael J Scott et al. Anesth Analg. 2024.

. 2024 Apr 1;138(4):713-724.

doi: 10.1213/ANE.0000000000006789. Epub 2023 Dec 28.

Authors

Michael J Scott^{1

2

3}; APSF Hemodynamic Instability Writing Group

Collaborators

APSF Hemodynamic Instability Writing Group:
Michael Scott⁴, Alparslan Turan⁵, Shane Angus⁶, Maxime Cannesson⁷, Daniel J Cole⁸, Deborah Culley⁹, Elizabeth Duggan¹⁰, Richard P Dutton¹¹, Jeffrey Feldman¹², Mike P W Grocott¹³, Oliver Huet¹⁴, Anne Huffenberger¹⁵, Allison M Janda¹⁶, Ashish K Khanna¹⁷, Clifford Ko¹⁸, Christina Matadial¹⁹, Matthew D McEvoy²⁰, Nirav Shah²¹, Joseph Szokol²², Louise Y Sun²³

Affiliations

¹ From the Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
² Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
³ Department of Anesthesia Critical Care and Pain Medicine, University College London, London, United Kingdom.
⁴ Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
⁵ Department of Anesthesiology & Department of Outcomes Research, Cleveland Clinic, OH. Editor-in-Chief, Journal of clinical Anesthesia. This author contributed to the discussion and data acquisition, and revision and final approval of the article. Dr Alparslan Tarun served as a consultant for CIVCO.
⁶ Department of Anesthesiology, Center for Medical Education, Case Western Reserve University, School of Medicine, Washington, DC. This author contributed to attending the conference, developing data acquisition methodology, interpretation of results, revision of the article, and final approval of the article. S. Angus has been a member of the Board of Directors for the Anesthesia Patient Safety Foundation.
⁷ Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California. This author contributed to performing a speech at the conference where the material in this article was generated, contributed to discussion and data acquisition, and contributed to writing, revision, and final approval of the article. M. Cannesson is a consultant for Edwards Lifesciences and Masimo Corp, and has funded research from Edwards Lifesciences and Masimo Corp. He is also the founder of Sironis and Perceptive Medical and he owns patents and receives royalties for closed-loop hemodynamic management technologies that have been licensed to Edwards Lifesciences. He received a grant from NIH R01EB029751.
⁸ Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California. This author contributed to the conference planning committee, chairing the conference, developing data acquisition methodology, interpretation of results, writing and revision of the article, and final approval of the article. D. J. Cole is the president of the Anesthesia Patient Safety Foundation, which sponsored the conference.
⁹ Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. This author contributed to attending the conference, developing data acquisition methodology, interpretation of results, revision of the article, and final approval of the article. D. Culley is the Co-Editor-in-Chief of Anesthesiology.
¹⁰ Department of Anesthesia, University of Alabama, Birmingham, Alabama. This author contributed to performing a speech at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article.
¹¹ Chief Quality Officer, US Anesthesia Partners, Dallas, Texas. This author spoke at the conference where the material in this article was generated, acquired consensus data, interpreted the results, and wrote and reviewed the article.
¹² Department of Anesthesiology, Children's Hospital of Philadelphia, Perelman School of Medicine - University of Pennsylvania, Philadelphia, PA 19104. Chair, APSF Committee on Technology. This author attended the conference, developing data acquisition methodology, interpretation of results, revision of the article, and final approval of the article. J. Feldman is Chair of the APSF Committee on Technology.
¹³ Department of Anesthesia and Critical Care, Southampton General Hospital, Tremona Road Shirley, Southampton SO16 6YD, UK. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. M. P. W. Grocott is deputy chair of the UK Centre for Perioperative Care, an elected council member and trustee of the Royal College of Anaesthetists, board chair of the UK National Institute of Academic Anaesthesia and joint editor-in-chief of Perioperative Medicine. He is an NIHR senior investigator and director of the NIHR Southampton Biomedical Research Centre. He has served as a consultant for Sphere Medical Ltd, South-West Sensors Ltd and Edwards Lifesciences.
¹⁴ Département d'Anesthésie-Réanimation, et Médecine Péri-Opératoire, CHRU de Brest, Université de Bretagne Occidentale, Hôpital de la Cavale Blanche, Bd Tanguy Prigent, 29609 Brest, France. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. O. Huet has received an honorarium from Edwards Life Sciences and Fresenius Kabi and research funding from Baxter.
¹⁵ Director of Penn Center for Connected Care, Penn Medicine Rittenhouse Campus, Philadelphia, PA 19146. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article.
¹⁶ Assistant Professor, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. A. M. Janda has received research funding paid to the University of Michigan from the National Institute of General Medical Sciences and National Heart, Lung, and Blood Institute of the National Institutes of Health under award numbers T32GM103730 and K23HL166685.
¹⁷ Department of Anesthesiology, Section on Critical Care Medicine, Perioperative Outcomes and Informatics Collaborative, Atrium Health Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, NC. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. A. K. Khanna consults for Medtronic, Edwards Life Sciences, Philips Research North America, Baxter, GE Healthcare, Potrero Medical, Fifth Eye Inc., Renibus Therapeutics, Retia Medical, and Caretaker Medical. He is also funded with a Clinical and Translational Science Institute (CTSI) NIH/NCTAS KL2 TR001421 award for a trial on continuous postoperative hemodynamic and saturation monitoring. The Department of Anesthesiology at Wake Forest School of Medicine is supported by Edwards Lifesciences under a master clinical trials agreement.
¹⁸ Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California. Director of the Division of Research and Optimal Patient Care at the American College of Surgeons and Director of ACS NSQIP. This author contributed to structuring of the data acquisition, interpretation of the results, writing and revision of the article and final approval of the article. C. Ko is the director of the Division of Research and Optimal Patient Care at the American College of Surgeons, and director of American College of Surgeons NSQIP.
¹⁹ Associate Professor of Clinical Anesthesiology, University of Miami Miller School of Medicine, Department of Anesthesiology, Perioperative Medicine and Pain Management, Associate Professor of Anesthesiology, Florida International University, Herbert Wertheim College of Medicine, Park, Florida. This author attended the conference, developing data acquisition methodology, interpretation of results, writing and revision of the article, and final approval of article.
²⁰ Professor of Anesthesiology and Surgery, Vice-Chair of Perioperative Medicine, Medical Director, VUMC Enhanced Recovery Programs, Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC 4648, Nashville, TN 37232. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article.
²¹ Associate Professor, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. N. J. Shah has recently received research funding paid to the University of Michigan from the National Library of Medicine and National Institute of Aging of the National Institutes of Health, Blue Cross Blue Michigan, Patient-Centered Outcomes Research Institute, Edwards Lifesciences, and Apple, Inc.
²² Keck School of Medicine of USC, 1500 San Pablo St, Health Science Campus, Los Angeles, CA 90033. Chief Policy Officer, American Society of Anesthesiologists. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article. J. Szokol is the chief policy officer at the American Society of Anesthesiologists.
²³ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Rm 3584B, Palo Alto, CA 94305. This author spoke at the conference where the material in this article was generated, contributed to the discussion and data acquisition, contributed to the writing, revision, and final approval of the article.

PMID: 38153876
PMCID: PMC10916753
DOI: 10.1213/ANE.0000000000006789

Erratum in

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation: Erratum.
[No authors listed] [No authors listed] Anesth Analg. 2025 Feb 1;140(2):e18. doi: 10.1213/ANE.0000000000007300. Epub 2025 Jan 10. Anesth Analg. 2025. PMID: 39804605 Free PMC article. No abstract available.

Abstract

In November of 2022, the Anesthesia Patient Safety Foundation held a Consensus Conference on Hemodynamic Instability with invited experts. The objective was to review the science and use expert consensus to produce best practice recommendations to address the issue of perioperative hemodynamic instability. After expert presentations, a modified Delphi process using discussions, voting, and feedback resulted in 17 recommendations regarding advancing the perioperative care of the patient at risk of, or with, hemodynamic instability. There were 17 high-level recommendations. These recommendations related to the following 7 domains: Current Knowledge (5 statements); Preventing Hemodynamic Instability-Related Harm During All Phases of Care (4 statements); Data-Driven Quality Improvement (3 statements); Informing Patients (2 statements); The Importance of Technology (1 statement); Launch a National Campaign (1 statement); and Advancing the Science (1 statement). A summary of the recommendations is presented in Table 1 .

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Conflict of interest statement

Conflicts of Interest: See Disclosures at the end of the article.

References

1. U.S. Department of Health and Human Services Office of Inspector General. Accessed March 12, 2023. https://oig.hhs.gov/oei/reports/OEI-06-18-00400.pdf.
1. Joint Commission. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-....
1. Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: how to decide its appropriateness. World J Methodol. 2021;11:116–129. - PMC - PubMed
1. Ackland GL, Brudney CS, Cecconi M, et al. ; Perioperative Quality Initiative-3 workgroup. Perioperative quality initiative consensus statement on the physiology of arterial blood pressure control in perioperative medicine. Br J Anaesth. 2019;122:542–551. - PubMed
1. Shah NJ, Mentz G, Kheterpal S. The incidence of intraoperative hypotension in moderate to high risk patients undergoing non-cardiac surgery: a retrospective multicenter observational analysis. J Clin Anesth. 2020;66:109961. - PubMed

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Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation

Collaborators

Affiliations

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation

Authors

Collaborators

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical