Individualized blood pressure regulation and acute kidney injury in older patients having major abdominal surgery: a pilot randomized trial

作者：Zhaohua Pang, Shuang Liang, Nannan Zhou, Xiaoyan Zhu, Qulian Guo, Daniel I. Sessler, Wangyuan Zou · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000002289 · 被引用次数：17 · 研究领域：Hemodynamic Monitoring and Therapy、Acute Kidney Injury Research、Abdominal Surgery and Complications

BACKGROUND: Acute kidney injury (AKI) is a common postoperative complication, and hypotension may contribute. We therefore tested the primary hypothesis that individualized intraoperative blood pressure regulation reduces postoperative AKI in older surgical patients. METHODS: We enrolled patients ≥60 years old scheduled for elective major abdominal surgery with invasive arterial pressure monitoring. All had goal-directed fluid management based on stroke volume variation cardiac output, and administration of a starch. Participants were randomly assigned to: (1) individualized blood pressure management targeting a systolic blood pressure (SBP) within -20% and +10% if baseline SBP was ≥130 mmHg or diastolic blood pressure was ≥80 mmHg, or otherwise, to target SBP within ±10% of the baseline value; (2) maintenance of SBP ≥90 mmHg and MAP ≥65 mmHg. Metaraminol was used to achieve the blood pressure target. AKI incidence was assessed by Kidney Disease Improving Global Outcomes criteria during the initial 7 postoperative days. RESULTS: 192 patients were assigned to individualized ( n = 96) or routine ( n = 96) pressure management. 179 patients were included in the intention-to-treat analysis. Age averaged 68 ± 5 (SD) years and 64% were male. Randomization to the individualized management reduced the area under MAP <65 mmHg (median difference: -37 [-47 to -25] mmHg-minute, P < 0.001]. The incidence of the AKI was 11% in patients assigned to individualized management vs. 16 % in those...