Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London
Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatmen...
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| Veröffentlicht in: | Perioperative medicine (London) 2016-05, Vol.5 (12), p.12-12, Article 12 |
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| creator | Wickham, Alex Highton, David Martin, Daniel |
| description | Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely unknown in the UK.
We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between low DOA values and IOH with increased mortality (as part of "double" and "triple low" phenomena) and because it is a suggested management strategy to reduce IOH.
Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition, but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial blood pressures |
| doi_str_mv | 10.1186/s13741-016-0036-1 |
| format | Article |
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We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between low DOA values and IOH with increased mortality (as part of "double" and "triple low" phenomena) and because it is a suggested management strategy to reduce IOH.
Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition, but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial blood pressures <50, <60, and <70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressure decrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients.
IOH is common and use of DOA monitors is less than implied by guidelines. Improved management of IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group.</description><identifier>ISSN: 2047-0525</identifier><identifier>EISSN: 2047-0525</identifier><identifier>DOI: 10.1186/s13741-016-0036-1</identifier><identifier>PMID: 27239298</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Aged patients ; Care and treatment ; Development and progression ; Evaluation ; Hypotension ; Methods ; Perioperative care ; Physiological aspects ; Practice guidelines (Medicine)</subject><ispartof>Perioperative medicine (London), 2016-05, Vol.5 (12), p.12-12, Article 12</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>Wickham et al. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c595t-6e1f52c4dadb76c7ac3ed6c7a7bfbcff25e51bde3754837cf55c4946a2f143283</citedby><cites>FETCH-LOGICAL-c595t-6e1f52c4dadb76c7ac3ed6c7a7bfbcff25e51bde3754837cf55c4946a2f143283</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882849/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882849/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27239298$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wickham, Alex</creatorcontrib><creatorcontrib>Highton, David</creatorcontrib><creatorcontrib>Martin, Daniel</creatorcontrib><creatorcontrib>Pan London Perioperative Audit and Research Network (PLAN)</creatorcontrib><creatorcontrib>The Pan London Perioperative Audit and Research Network (PLAN)</creatorcontrib><title>Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London</title><title>Perioperative medicine (London)</title><addtitle>Perioper Med (Lond)</addtitle><description>Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely unknown in the UK.
We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between low DOA values and IOH with increased mortality (as part of "double" and "triple low" phenomena) and because it is a suggested management strategy to reduce IOH.
Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition, but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial blood pressures <50, <60, and <70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressure decrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients.
IOH is common and use of DOA monitors is less than implied by guidelines. Improved management of IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group.</description><subject>Aged patients</subject><subject>Care and treatment</subject><subject>Development and progression</subject><subject>Evaluation</subject><subject>Hypotension</subject><subject>Methods</subject><subject>Perioperative care</subject><subject>Physiological aspects</subject><subject>Practice guidelines (Medicine)</subject><issn>2047-0525</issn><issn>2047-0525</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNptks1u1DAUhSMEolXpA7BBlpAQm5T4L05YILUjfiqNxAJYW4593bjK2CF2Rpp34KFxZkqZQcQLJ77fOXauT1G8xNUVxk39LmIqGC4rXJdVResSPynOScVEWXHCnx69nxWXMd5X-Wl4g1vxvDgjgtCWtM158WulJkDBIhgMTMMOjSo58Cm-RwqNU4gj6OS2gNRsXFrA1EMuwFYN4PVe2u_GkMBHFzxS3uyJOe5LN7ffkPNpUmGESS1GeQvnEeGoz94uqSEu3-vgTfAvimc2L8Dlw3xR_Pj08fvqS7n--vl2db0uNW95KmvAlhPNjDKdqLVQmoJZZtHZTltLOHDcGaCCs4YKbTnXrGW1IhYzShp6UXw4-I5ztwGjYTnhIMfJbdS0k0E5eVrxrpd3YStZ05CGtdng7YPBFH7OEJPcuKhhGJSHMEeJRUuEIFzwjL7-B70P8-Tz7y1U3daipuwvdZfbKp23Ie-rF1N5zTjlpOWNyNTVf6g8DGycDh6sy-sngjdHgh7UkPoYhjnlq4qnID6AOl95nMA-NgNXcombPMRN5rjJJW4SZ82r4y4-Kv6Ei_4GWTzQnQ</recordid><startdate>20160527</startdate><enddate>20160527</enddate><creator>Wickham, Alex</creator><creator>Highton, David</creator><creator>Martin, Daniel</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160527</creationdate><title>Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London</title><author>Wickham, Alex ; Highton, David ; Martin, Daniel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c595t-6e1f52c4dadb76c7ac3ed6c7a7bfbcff25e51bde3754837cf55c4946a2f143283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged patients</topic><topic>Care and treatment</topic><topic>Development and progression</topic><topic>Evaluation</topic><topic>Hypotension</topic><topic>Methods</topic><topic>Perioperative care</topic><topic>Physiological aspects</topic><topic>Practice guidelines (Medicine)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wickham, Alex</creatorcontrib><creatorcontrib>Highton, David</creatorcontrib><creatorcontrib>Martin, Daniel</creatorcontrib><creatorcontrib>Pan London Perioperative Audit and Research Network (PLAN)</creatorcontrib><creatorcontrib>The Pan London Perioperative Audit and Research Network (PLAN)</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Perioperative medicine (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wickham, Alex</au><au>Highton, David</au><au>Martin, Daniel</au><aucorp>Pan London Perioperative Audit and Research Network (PLAN)</aucorp><aucorp>The Pan London Perioperative Audit and Research Network (PLAN)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London</atitle><jtitle>Perioperative medicine (London)</jtitle><addtitle>Perioper Med (Lond)</addtitle><date>2016-05-27</date><risdate>2016</risdate><volume>5</volume><issue>12</issue><spage>12</spage><epage>12</epage><pages>12-12</pages><artnum>12</artnum><issn>2047-0525</issn><eissn>2047-0525</eissn><abstract>Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely unknown in the UK.
We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between low DOA values and IOH with increased mortality (as part of "double" and "triple low" phenomena) and because it is a suggested management strategy to reduce IOH.
Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition, but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial blood pressures <50, <60, and <70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressure decrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients.
IOH is common and use of DOA monitors is less than implied by guidelines. Improved management of IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27239298</pmid><doi>10.1186/s13741-016-0036-1</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | Springer Nature - Complete Springer Journals; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access; Springer Nature OA Free Journals |
| subjects | Aged patients Care and treatment Development and progression Evaluation Hypotension Methods Perioperative care Physiological aspects Practice guidelines (Medicine) |
| title | Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London |
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