University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, United States of America.
Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States of America.
J Clin Anesth. 2024 Oct;97:111561. doi: 10.1016/j.jclinane.2024.111561. Epub 2024 Jul 24.
The hemodynamic assessment of patients with left ventricular assist devices (LVAD) using noninvasive blood pressure (NIBP) monitoring may be unreliable without pulsatile blood flow. The primary goal of this study is to examine the association between intraoperative blood pressure monitoring gaps of 10 min or greater and LVAD type in patients undergoing noncardiac surgeries with NIBP monitors at induction.
Retrospective cohort.
Single institution, academic university hospital.
One-hundred fifteen patients undergoing 187 noncardiac surgeries without arterial lines at induction.
Noncardiac surgery.
The primary outcome was the association of blood pressure monitoring gaps, which were defined as ten minutes or greater, and LVAD type including the HeartMate 2 (HM2; Abbott, Chicago, IL) and the HeartMate 3 (HM3; Abbott, Chicago, IL), as evaluated by multivariable logistic regression analysis.
After adjusting for patient characteristics, HM3 was associated with lower odds of monitoring gaps (p = 0.02). Additionally, the odds of a monitoring gap were higher in patients with morbid obesity (p = 0.04) and in surgical duration longer than 180 min (p = 0.001). In the post-hoc analysis, morbid obesity, general anesthesia, and prolonged surgeries were found to be associated with increased odds of arterial line placement after induction (p = 0.05, p = 0.007, p < 0.001).
Patients with a HM2 undergoing noncardiac surgery had nearly three-fold higher odds of blood pressure monitoring gaps of 10 min or greater compared to patients with a HM3. Morbid obesity and prolonged surgical duration were also associated with a significant increase in monitoring gaps. Morbid obesity, general anesthesia, and longer surgical duration were found to have a greater odds of arterial line placement after induction. These results may help anesthesiologists determine the appropriateness of NIBP in patients with LVADs undergoing noncardiac surgeries.
在使用非侵入性血压（NIBP）监测的情况下，由于缺乏脉动血流，左心室辅助装置（LVAD）患者的血流动力学评估可能不可靠。本研究的主要目的是检查术中血压监测间隔 10 分钟或更长时间与诱导时使用 NIBP 监测仪进行非心脏手术的 LVAD 类型之间的关联。
回顾性队列研究。
单一机构，学术大学医院。
115 名接受非心脏手术且诱导时无动脉线的患者，共进行了 187 例非心脏手术。
非心脏手术。
主要结果是血压监测间隔（定义为 10 分钟或更长时间）与 LVAD 类型之间的关联，LVAD 类型包括 HeartMate 2（HM2；雅培，芝加哥，IL）和 HeartMate 3（HM3；雅培，芝加哥，IL），通过多变量逻辑回归分析进行评估。
调整患者特征后，HM3 与较低的监测间隔可能性相关（p=0.02）。此外，病态肥胖患者（p=0.04）和手术时间超过 180 分钟的患者（p=0.001）监测间隔的可能性更高。在事后分析中，病态肥胖、全身麻醉和手术时间延长与诱导后动脉置管的可能性增加相关（p=0.05、p=0.007、p<0.001）。
与 HM3 相比，接受非心脏手术的 HM2 患者血压监测间隔 10 分钟或更长时间的可能性几乎高出三倍。病态肥胖和手术时间延长也与监测间隔显著增加相关。病态肥胖、全身麻醉和较长的手术时间与诱导后动脉置管的可能性更大相关。这些结果可能有助于麻醉师确定 NIBP 在接受非心脏手术的 LVAD 患者中的适用性。
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