PeriOperative Quality Initiative (POQI) international consensus statement on perioperative arterial pressure...

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Surgical Outcomes

Background:

• Hemodynamic therapy, including arterial pressure management, is critical for surgical patients.
• The 11th PeriOperative Quality Initiative (POQI) consensus conference convened international experts to update guidelines on perioperative arterial pressure management.

Framework:

• Recommendations developed using a modified Delphi approach.
• Key recommendation: maintain intraoperative mean arterial pressure (MAP) ≥60 mm Hg in at-risk patients.
• Suggests increasing MAP targets with elevated venous or compartment pressures and treating hypotension based on causes.

Implementation:

• Continuous intraoperative arterial pressure monitoring is favored over intermittent monitoring to reduce hypotension severity and duration.
• Emphasizes careful treatment of intraoperative hypertension to prevent subsequent hypotension.
• Highlights the often-unrecognized significance of prolonged, untreated postoperative hypotension.

Implications:

• Need for further research into patient-specific and organ-specific hypotension harm thresholds.
• Future research should identify optimal treatment strategies for intraoperative hypotension, including vasopressor selection.
• Calls for research to guide strategies for recognizing, preventing, and treating postoperative hypotension.