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Personalization of arterial pressure in the perioperative period

Godet, Thomasa; Grobost, Romaina; Futier, Emmanuela,b

Current Opinion in Critical Care: December 2018 - Volume 24 - Issue 6 - p 554–559
doi: 10.1097/MCC.0000000000000548
THE SURGICAL PATIENT: Edited by Karim Asehnoune
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Purpose of review This review aims to discuss recent findings on the relationship between intraoperative arterial hypotension and organ dysfunction in surgical patients and examines the available evidence for personalizing blood pressure (BP) management as a strategy to improve patient outcome.

Recent findings Hypotension contributes to oxygen supply–demand mismatch and may cause an ischemia–reperfusion injury which may manifest as organ dysfunction. Evidence is accumulating suggesting that hypotension is associated with acute postoperative myocardial and kidney injury, and increased risk of mortality in surgical patients. In contrast to traditional BP management in which BP targets are empirically chosen, personalized BP management aims at individualizing BP targets according to individual patient physiology considering clinical conditions that may influence organ pressure-flow autoregulation. Recent randomized data provide clinically meaningful findings that a treatment strategy aims at targeting individualized BP values which may help improving outcome in surgical patients.

Summary Hypotension is a common complication in surgical patients and is an important trigger of organ injury in surgical patients. Personalized BP management may contribute at reducing postoperative organ dysfunction in surgical patients.

aDepartment of Perioperative Medicine, Anesthesiology and Critical Care, University Teaching Hospital of Clermont-Ferrand

bUniversity Clermont Auvergne, CNRS, Inserm, Clermont-Ferrand, France

Correspondence to Emmanuel Futier, Département de Médecine Périopératoire, Anesthésie et Réanimation, Hôpital Estaing, 1 place Lucie Aubrac, 63003 Clermont-Ferrand, cedex 1, France. Tel: +33 47 3750476; e-mail: efutier@chu-clermontferrand.fr

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