Personalised blood pressure management during major noncardiac surgery and postoperative neurocognitive disorders: a randomised trial

Abstract

BackgroundIt 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 non-cardiac surgery. MethodsIn this single-centre trial, 328 elective major non-cardiac 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-hour blood pressure monitoring) or routine blood pressure management (i.e., maintaining MAP above 65 mmHg). The primary outcome was the incidence of neurocognitive disorders (composite of delayed neurocognitive recovery and delirium) between postoperative days 3 and 7. ResultsThe 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 (OR=0.84, 95%-CI: 0.40–1.75, p=0.622). Delayed neurocognitive recovery occurred in 17 of 146 (12%) personalised and 17 of 145 (12%) routine blood pressure management patients (OR=0.99, 95%-CI: 0.45–2.17, p=0.983). Delirium occurred in 2 of 157 (1%) personalised and 4 of 158 (3%) routine blood pressure management patients (OR=0.50, 95%-CI: 0.04–3.53, p=0.684). ConclusionsPersonalised intraoperative blood pressure management maintaining preoperative baseline MAP did neither reduce 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 non-cardiac surgery. Trial registrationClinicalTrials.gov, NCT03442907, on February 22, 2018.