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Automated control of postoperative hypertension: a prospective, randomized multicenter study
D M Cosgrove1, J H Petre, J L Waller
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195-5066.
The Annals of Thoracic Surgery
|May 1, 1989
Summary
Post-cardiac surgery hypertension is common. An automatic sodium nitroprusside system improved blood pressure control, reducing hypertension and hypotension compared to manual methods.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Clinical Engineering
Background:
- Postoperative hypertension is frequent after cardiac surgery.
- Complications include bleeding, suture line disruption, ischemia, and cerebrovascular accidents.
- Sodium nitroprusside is a common treatment to prevent these complications.
Purpose of the Study:
- To evaluate a closed-loop automatic sodium nitroprusside system for arterial blood pressure control.
- To compare its performance against manual infusion control in cardiac surgical patients.
Main Methods:
- Prospective, randomized multicenter study.
- 180 postoperative cardiac surgical patients.
- Comparison between automatic closed-loop and manual sodium nitroprusside administration.
Main Results:
- Mean arterial blood pressure adherence to +/- 10% target was 85% with the automatic system vs. 61% manually (p<0.0001).
- The automatic system showed significantly less hypertension (9% vs. 22%) and hypotension (6% vs. 22%).
- Reduced chest tube drainage (720 mL vs. 840 mL; p<0.05) was observed with the automatic system.
Conclusions:
- The automatic closed-loop system provides superior arterial blood pressure control post-cardiac surgery.
- This system achieves better hypertension management more rapidly with less nurse intervention.
- Improved blood pressure control may reduce postoperative complications like excessive bleeding.