Lurati Buse Giovanna, Bollen Pinto Bernardo, Abelha Fernando, Abbott Tom E F, Ackland Gareth, Afshari Arash, De Hert Stefan, Fellahi Jean-Luc, Giossi Laure, Kavsak Peter, Longrois Dan, M'Pembele Rene, Nucaro Anthony, Popova Ekaterine, Puelacher Christian, Richards Toby, Roth Sebastian, Sheka Mootii, Szczeklik Wojciech, van Waes Judith, Walder Bernhard, Chew Michelle S
From the Department of Anaesthesiology, University Hospital Dusseldorf, Dusseldorf, Germany (GLB, RMP, AN, SR), Division of Anaesthesiology, Geneva University Hospitals (HUG), Geneva, Switzerland (BBP, MS, BW), Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, Portugal (FA), Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal (FA), William Harvey Research Institute, Queen Mary University of London, London, UK (TEA, GA), Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK (GA), Department of Paediatric and Obstetric Anaesthesia, Rigshospitalet & Department of Clinical Medicine, Copenhagen University, Denmark (AA), Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH), Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69500 Lyon, France (J-LF), "Patients as Partners" program, Geneva University Hospitals (HUG), Geneva, Switzerland (LG), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (PK), Department of Anesthesiology and Intensive Care, Bichat Claude-Bernard Hospital, Assistance Publique-Hopitaux de Paris - Nord, University of Paris, INSERM U1148, Paris, France (DL), Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain (EP), Centro Cochrane Iberoamericano, Barcelona, Spain (EP), Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel-Stadt, Switzerland (CP), Department of Internal Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland (CP), Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia (TR), Institute of Clinical Trials and Methodology and Division of Surgery, University College London, UK (TR), Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland (WS), Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (JvW), Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University Hospital, Sweden (MSC).
Eur J Anaesthesiol. 2023 Dec 1;40(12):888-927. doi: 10.1097/EJA.0000000000001865. Epub 2023 Jun 1.
In recent years, there has been increasing focus on the use of cardiac biomarkers in patients undergoing noncardiac surgery.
The aim of this focused guideline was to provide updated guidance regarding the pre-, post- and combined pre-and postoperative use of cardiac troponin and B-type natriuretic peptides in adult patients undergoing noncardiac surgery.
The guidelines were prepared using Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. This included the definition of critical outcomes, a systematic literature search, appraisal of certainty of evidence, evaluation of biomarker measurement in terms of the balance of desirable and undesirable effects including clinical outcomes, resource use, health inequality, stakeholder acceptance, and implementation. The panel differentiated between three different scopes of applications: cardiac biomarkers as prognostic factors, as tools for risk prediction, and for biomarker-enhanced management strategies.
In a modified Delphi process, the task force defined 12 critical outcomes. The systematic literature search resulted in over 25,000 hits, of which 115 full-text articles formed the body of evidence for recommendations. The evidence appraisal indicated heterogeneity in the certainty of evidence across critical outcomes. Further, there was relevant gradient in the certainty of evidence across the three scopes of application. Recommendations were issued and if this was not possible due to limited evidence, clinical practice statements were produced.
The ESAIC focused guidelines provide guidance on the perioperative use of cardiac troponin and B-type natriuretic peptides in patients undergoing noncardiac surgery, for three different scopes of application.
近年来，非心脏手术患者使用心脏生物标志物受到越来越多的关注。
本重点指南旨在为成年非心脏手术患者术前、术后以及术前和术后联合使用心肌肌钙蛋白和B型利钠肽提供最新指导。
本指南采用推荐分级评估、制定与评价（GRADE）方法制定。这包括关键结局的定义、系统的文献检索、证据确定性评估、从有利和不利影响（包括临床结局、资源使用、健康不平等、利益相关者接受度和实施情况）的平衡角度对生物标志物测量进行评估。该小组区分了三种不同的应用范围：心脏生物标志物作为预后因素、作为风险预测工具以及用于生物标志物强化管理策略。
在一个经过改进的德尔菲过程中，工作组确定了12个关键结局。系统的文献检索结果超过25000条记录，其中115篇全文文章构成了推荐建议的证据主体。证据评估表明，各关键结局的证据确定性存在异质性。此外，在三个应用范围内，证据确定性存在相关梯度。发布了推荐建议，若因证据有限无法发布，则生成临床实践声明。
欧洲麻醉与重症监护学会（ESAIC）重点指南针对非心脏手术患者围手术期使用心肌肌钙蛋白和B型利钠肽，给出了三种不同应用范围的指导意见。
