Association of velocity-pressure loop-derived values recorded during neurosurgical procedures with postoperative organ failure biomarkers: a retrospective single-center study.

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  • Additional Information
    • Source:
      Publisher: Published by Elsevier Masson SAS on behalf of the Société française d'anesthésie et de réanimation (Sfar) Country of Publication: France NLM ID: 101652401 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2352-5568 (Electronic) Linking ISSN: 23525568 NLM ISO Abbreviation: Anaesth Crit Care Pain Med Subsets: MEDLINE
    • Publication Information:
      Original Publication: Issy-les-Moulineaux cedex, France : Published by Elsevier Masson SAS on behalf of the Société française d'anesthésie et de réanimation (Sfar), [2015]-
    • Subject Terms:
      Biomarkers*/blood ; Neurosurgical Procedures* ; Postoperative Complications*/epidemiology ; Postoperative Complications*/blood ; Postoperative Complications*/diagnosis; Humans ; Retrospective Studies ; Middle Aged ; Male ; Female ; Aged ; Adult ; Cardiac Output ; Monitoring, Intraoperative/methods ; Multiple Organ Failure/blood ; Multiple Organ Failure/etiology ; Arterial Pressure ; Natriuretic Peptide, Brain/blood
    • Abstract:
      Background: Perioperative renal and myocardial protection primarily depends on preoperative prediction tools, along with intraoperative optimization of cardiac output (CO) and mean arterial pressure (MAP). We hypothesise that monitoring the intraoperative global afterload angle (GALA), a proxy of ventricular afterload derived from the velocity pressure (VP) loop, could better predict changes in postoperative biomarkers than the recommended traditional MAP and CO.
      Method: This retrospective monocentric study included patients programmed for neurosurgery with continuous VP loop monitoring. Patients with hemodynamic instability were excluded. Those presenting a 1-day post-surgery increase in creatinine, B-type natriuretic peptide, or troponin Ic us were labelled Bio+, Bio- otherwise. Demographics, intra-operative data, and comorbidities were considered as covariates. The study aimed to determine if intraoperative GALA monitoring could predict early postoperative biomarker disruption.
      Result: From November 2018 to November 2020, 86 patients were analysed (Bio+/Bio- = 47/39). Bio+ patients were significantly older (62 [54-69] vs. 42 [34-57] years, p <  0.0001), More often hypertensive (25% vs. 9%, p = 0.009), and more frequently treated with antihypertensive drugs (31.9% vs. 7.7%, p = 0.013). GALA was significantly larger in Bio+ patients (40 [31-56] vs. 23 [19-29] °, p < 0.0001), while CO, MAP, and cumulative time spent <65mmHg were similar between groups. GALA exhibited strong predictive performances for postoperative biological deterioration (AUC = 0.88 [0.80-0.95]), significantly outperforming MAP (MAP AUC = 0.55 [0.43-0.68], p < 0.0001).
      Conclusion: GALA under general anaesthesia prove more effective in detecting patients at risk of early cardiac or renal biological deterioration, compared to classical hemodynamic parameters.
      (Copyright © 2024. Published by Elsevier Masson SAS.)
    • Contributed Indexing:
      Keywords: Afterload monitoring; Arterial system; General anaesthesia; Hemodynamic; Postoperative complications; Prediction
    • Accession Number:
      0 (Biomarkers)
      114471-18-0 (Natriuretic Peptide, Brain)
    • Publication Date:
      Date Created: 20240712 Date Completed: 20241018 Latest Revision: 20241018
    • Publication Date:
      20241020
    • Accession Number:
      10.1016/j.accpm.2024.101405
    • Accession Number:
      38997007