title: Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension.
abstract: BACKGROUND
  Intraoperative hypotension may contribute to postoperative acute kidney injury (AKI) and myocardial injury, but what blood pressures are unsafe is unclear. The authors evaluated the association between the intraoperative mean arterial pressure (MAP) and the risk of AKI and myocardial injury.
  
  
  METHODS
  The authors obtained perioperative data for 33,330 noncardiac surgeries at the Cleveland Clinic, Ohio. The authors evaluated the association between intraoperative MAP from less than 55 to 75 mmHg and postoperative AKI and myocardial injury to determine the threshold of MAP where risk is increased. The authors then evaluated the association between the duration below this threshold and their outcomes adjusting for potential confounding variables.
  
  
  RESULTS
  AKI and myocardial injury developed in 2,478 (7.4%) and 770 (2.3%) surgeries, respectively. The MAP threshold where the risk for both outcomes increased was less than 55 mmHg. Compared with never developing a MAP less than 55 mmHg, those with a MAP less than 55 mmHg for 1-5, 6-10, 11-20, and more than 20 min had graded increases in their risk of the two outcomes (AKI: 1.18 [95% CI, 1.06-1.31], 1.19 [1.03-1.39], 1.32 [1.11-1.56], and 1.51 [1.24-1.84], respectively; myocardial injury 1.30 [1.06-1.5], 1.47 [1.13-1.93], 1.79 [1.33-2.39], and 1.82 [1.31-2.55], respectively].
  
  
  CONCLUSIONS
  Even short durations of an intraoperative MAP less than 55 mmHg are associated with AKI and myocardial injury. Randomized trials are required to determine whether outcomes improve with interventions that maintain an intraoperative MAP of at least 55 mmHg.
authors.affiliation: Departments of Medicine, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. lastwalsh1975@gmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Walsh
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.forename: Reitze N
authors.initials: RN
authors.lastname: Rodseth
authors.forename: Jacek
authors.initials: J
authors.lastname: Cywinski
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D062186:Arterial Pressure; D009202:Cardiomyopathies / Q000209:etiology*; D015331:Cohort Studies; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000401:mortality; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome