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Randomized Controlled Trial
. 2025 Jan:100:111687.
doi: 10.1016/j.jclinane.2024.111687. Epub 2024 Nov 27.

Personalized perioperative blood pressure management in patients having major non-cardiac surgery: A bicentric pilot randomized trial

Alina Bergholz  1 , Linda Grüßer  2 , Wiam T A K Khader  2 , Pawel Sierzputowski  1 , Linda Krause  3 , Marc Hein  2 , Julia Wallqvist  2 , Sebastian Ziemann  2 , Kristen K Thomsen  4 , Moritz Flick  1 , Philipp Breitfeld  5 , Moritz Waldmann  6 , Ana Kowark  7 , Mark Coburn  7 , Karim Kouz  4 , Bernd Saugel  8
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Free article
Randomized Controlled Trial

Personalized perioperative blood pressure management in patients having major non-cardiac surgery: A bicentric pilot randomized trial

Alina Bergholz et al. J Clin Anesth. 2025 Jan.
Free article

Abstract

Study objective: We hypothesize that personalized perioperative blood pressure management maintaining intraoperative mean arterial pressure (MAP) above the preoperative mean nighttime MAP reduces perfusion-related organ injury compared to maintaining intraoperative MAP above 65 mmHg in patients having major non-cardiac surgery. Before testing this hypothesis in a large-scale trial, we performed this bicentric pilot trial to determine a) if performing preoperative automated nighttime blood pressure monitoring to calculate personalized intraoperative MAP targets is feasible; b) in what proportion of patients the preoperative mean nighttime MAP clinically meaningfully differs from a MAP of 65 mmHg; and c) if maintaining intraoperative MAP above the preoperative mean nighttime MAP is feasible in patients having major non-cardiac surgery.

Design: Bicentric pilot randomized trial.

Setting: University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and RWTH Aachen University Hospital, Aachen, Germany.

Patients: Patients ≥ 45 years old having major non-cardiac surgery.

Interventions: Personalized blood pressure management.

Measurements: Proportion of patients in whom preoperative automated nighttime blood pressure monitoring was possible; proportion of patients in whom the preoperative mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg (difference > ±10 mmHg); intraoperative time-weighted average MAP below the preoperative mean nighttime MAP.

Main results: We enrolled 105 patients and randomized 98 patients. In 98 patients (93 %), preoperative automated nighttime blood pressure monitoring was possible. In 83 patients (85 %), the preoperative mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg. The median time-weighted average MAP below the preoperative mean nighttime MAP was 3.29 (1.64, 6.82) mmHg in patients assigned to personalized blood pressure management.

Conclusions: It seems feasible to determine the effect of personalized perioperative blood pressure management maintaining intraoperative MAP above the preoperative mean nighttime MAP on postoperative complications in a large multicenter trial.

Keywords: Anesthesia; Cardiovascular dynamics; Hemodynamic monitoring; Individualized; Morbidity; Mortality; Randomized controlled trial.

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Conflict of interest statement

Declaration of competing interest AB, LG, WTAKK, PS, LK, MH, JW, SZ, KKT, PB, MW, and AK declare that they have no conflict of interest related to this trial. MF is a consultant for Edwards Lifesciences (Irvine, CA, USA) and has received honoraria for consulting and giving lectures from CNSystems Medizintechnik (Graz, Austria). KK is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). KK is a consultant for Vygon (Aachen, Germany). MC is a speaker of the Trials Center (Studien Zentrum), German Society of Anaesthesiology and Intensive Care Medicine (DGAI) and Chair of the Reseach Committee of the European Society of Anesthesiology and Intensive Care (ESAIC). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). BS is a consultant for Philips North America (Cambridge, MA, USA) and has received honoraria for giving lectures from Philips Medizin Systeme Böblingen (Böblingen, Germany). BS has received institutional restricted research grants and honoraria for giving lectures from Baxter (Deerfield, IL, USA). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from GE Healthcare (Chicago, IL, USA). BS has received institutional restricted research grants and honoraria for giving lectures from CNSystems Medizintechnik (Graz, Austria). BS is a consultant for Maquet Critical Care (Solna, Sweden). BS has received honoraria for giving lectures from Getinge (Gothenburg, Sweden). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Pulsion Medical Systems (Feldkirchen, Germany). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Vygon (Aachen, Germany). BS is a consultant for and has received institutional restricted research grants from Retia Medical (Valhalla, NY, USA). BS has received honoraria for giving lectures from Masimo (Neuchâtel, Switzerland). BS is a consultant for Dynocardia (Cambridge, MA, USA). BS has received institutional restricted research grants from Osypka Medical (Berlin, Germany). BS received honoraria for giving lectures from Ratiopharm (Ulm, Germany). BS was a consultant for and has received institutional restricted research grants from Tensys Medical (San Diego, CA, USA). BS is an Editor of the British Journal of Anaesthesia.

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