Control of Postoperative Hypotension Using a Closed-Loop System for Norepinephrine Infusion in Patients After Cardiac Surgery: A Randomized Trial.
Control of Postoperative Hypotension Using a Closed-Loop System for Norepinephrine Infusion in Patients After Cardiac Surgery: A Randomized Trial.
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DOI：
10.1213/ane.0000000000005888
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发表时间：
2022-05-01
影响因子：
5.7
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中科院分区：
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血管加压药是治疗血管舒张性低血压的基础。血管加压素输注目前是手动调节的，以达到预定义的动脉压目标。我们开发了一种闭环血管加压药（CLV）控制器，以帮助更有效地纠正围手术期的低血压。我们测试了这样一个假设，即与接受标准管理的患者相比，心脏手术后使用这种系统管理的患者会出现更少的低血压。共有40例心脏手术后入住重症监护室（ICU）的患者随机分为2组，研究时间为2小时。在所有患者中，目标是使用去甲肾上腺素将平均动脉压（MAP）维持在65 - 75 mm Hg之间。在CLV组中，通过CLV系统控制去甲肾上腺素输注;在对照组中，由ICU护士手动调节。两组均使用与高级血流动力学监测系统相连的辅助液体管理系统进行标准化液体管理。主要结果是在研究期间，患者发生水肿（定义为MAP <65 mmHg）的时间百分比。在2小时的研究期间，CLV组发生低血压的时间百分比显著低于对照组（1.4% [0.9-2.3] vs 12.5% [9.9-24.3];位置差异，-9.8%[95%CI，-5.4至-15.9]; P <0.001）。CLV组MAP在65 - 75 mmHg之间的时间百分比也更高（95% [89-96] vs 66% [59-77];位置差异，27.6% [95%CI，34.3-19.0]; P <0.001）。CLV组患者MAP >75 mm Hg（仍在输注去甲肾上腺素）的时间百分比也显著低于对照组（3.2% [1.9-5.4] vs 20.6% [8.9-32.5];位置差异，-17%[95%CI，-10至-24]; P < .001）。在研究期间，CLV组去甲肾上腺素输注速率调整的次数多于对照组（581 [548-597] vs 13 [11-14];位置差异，568 [578-538]; P < .001）。两组在研究期间均未发生不良事件。与手动控制相比，闭环控制去甲肾上腺素输注可显著降低心脏手术后入住ICU的患者的术后低血压。（Anesth Analg 2022;134：964-73）
Vasopressors are a cornerstone for the management of vasodilatory hypotension. Vasopressor infusions are currently adjusted manually to achieve a predefined arterial pressure target. We have developed a closed-loop vasopressor (CLV) controller to help correct hypotension more efficiently during the perioperative period. We tested the hypothesis that patients managed using such a system postcardiac surgery would present less hypotension compared to patients receiving standard management. A total of 40 patients admitted to the intensive care unit (ICU) after cardiac surgery were randomized into 2 groups for a 2-hour study period. In all patients, the objective was to maintain mean arterial pressure (MAP) between 65 and 75 mm Hg using norepinephrine. In the CLV group, the norepinephrine infusion was controlled via the CLV system; in the control group, it was adjusted manually by the ICU nurse. Fluid administration was standardized in both groups using an assisted fluid management system linked to an advanced hemodynamic monitoring system. The primary outcome was the percentage of time patients were hypotensive, defined as MAP <65 mm Hg, during the study period. Over the 2-hour study period, the percentage of time with hypotension was significantly lower in the CLV group than that in the control group (1.4% [0.9–2.3] vs 12.5% [9.9–24.3]; location difference, −9.8% [95% CI, −5.4 to −15.9]; P < .001). The percentage of time with MAP between 65 and 75 mm Hg was also greater in the CLV group (95% [89–96] vs 66% [59–77]; location difference, 27.6% [95% CI, 34.3–19.0]; P < .001). The percentage of time with an MAP >75 mm Hg (and norepinephrine still being infused) was also significantly lower in patients in the CLV group than that in the control group (3.2% [1.9–5.4] vs 20.6% [8.9–32.5]; location difference, −17% [95% CI, −10 to −24]; P < .001). The number of norepinephrine infusion rate modifications over the study period was greater in the CLV group than that in the control group (581 [548–597] vs 13 [11–14]; location difference, 568 [578–538]; P < .001). No adverse event occurred during the study period in both groups. Closed-loop control of norepinephrine infusion significantly decreases postoperative hypotension compared to manual control in patients admitted to the ICU after cardiac surgery. (Anesth Analg 2022;134:964–73)