Intensive Care Unit, Hospital Sao Rafael, Salvador, Brazil.
UNIME Medical School, Lauro de Freitas, Brazil.
Intern Med J. 2020 Jan;50(1):61-69. doi: 10.1111/imj.14374.
Hypotension following orthopaedic surgery has been associated with increased morbidity and mortality. Rapid response teams (RRT) review patients on hospital wards with hypotension.
To evaluate the epidemiology of hypotensive RRT activations in adult orthopaedic patients to identify contributing factors and areas for future quality improvement.
Timing of RRT activations, presumed causes of hypotension and associated treatments were assessed.
Among 963 RRT activations in 605 patients over 3 years, the first calls of 226 of 605 patients were due to hypotension, and 213 (94.2%) of 226 had sufficient data for analysis. The median age was 79 (interquartile range 66-87) years; 58 (27.2%) were male, and comorbidities were common. Most (68%) surgery was emergent, and 75.1% received intraoperative vasopressors for hypotension. Most activations occurred within 24 h of surgery, and hypovolaemia, infection and arrhythmias were common presumed causes. Fluid boluses occurred in 173 (81.2%), and the time between surgery and RRT activation was 10 (4.0-26.5) h. in cases where fluid boluses were given, compared with 33 (15.5-61.5) h. where they were not (P < 0.001). Blood transfusion (30, 14.1%) and withholding of medications were also common. Hospital mortality was 8.5% (18), and 13.6% (29) were admitted to critical care at some stage. In-hospital death was associated with older age, functional dependence, arrhythmia and presumed infection.
Hypotension-related RRT calls in orthopaedic patients are common. Future interventional studies might focus on perioperative fluid therapy and vaso-active medications, as well as withholding of anti-hypertensive medications preoperatively.
矫形手术后出现低血压与发病率和死亡率增加有关。快速反应小组（RRT）会对病房中有低血压的患者进行检查。
评估成人矫形患者中低血压 RRT 激活的流行病学情况，以确定促成因素和未来质量改进的领域。
评估了 RRT 激活的时间、低血压的推测原因以及相关治疗。
在 3 年期间对 605 名患者中的 963 次 RRT 激活中，605 名患者中的 226 名患者的首次呼叫是由于低血压，其中 213 名（94.2%）有足够的数据进行分析。患者的中位年龄为 79 岁（四分位距 66-87 岁）；58 名（27.2%）为男性，且合并症常见。大多数（68%）手术为急诊手术，75.1%的患者在术中接受了血管加压药以治疗低血压。大多数激活发生在手术后 24 小时内，低血容量、感染和心律失常是常见的推测原因。173 例（81.2%）患者接受了液体冲击治疗，从手术到 RRT 激活的时间为 10（4.0-26.5）小时。与未接受液体冲击治疗的患者（33 例，15.5-61.5 小时）相比，接受液体冲击治疗的患者的时间更短（P<0.001）。输血（30 例，14.1%）和停止用药也很常见。住院死亡率为 8.5%（18 例），13.6%（29 例）在某个阶段被收入重症监护病房。院内死亡与年龄较大、功能依赖、心律失常和推测感染有关。
矫形患者中与低血压相关的 RRT 呼叫很常见。未来的干预性研究可能侧重于围手术期液体治疗和血管活性药物，以及术前停止使用抗高血压药物。
