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In patients after cardiac surgery, disturbances in macrocirculatory fluctuations and tissue perfusion commonly coexist. The stress state induced by factors such as surgical manipulation, cardiopulmonary bypass, anesthetic agents, pain, and ischemia-reperfusion injury, along with the use of vasoactive drugs postoperatively, often leads to increased blood pressure fluctuations in the early postoperative period. Additionally, dysregulation of organ blood flow autoregulation post-surgery contributes to peripheral circulatory impairment, rendering perfusion pressure an unreliable indicator of actual organ perfusion. We aim to assess postoperative blood pressure fluctuation using blood pressure variability and evaluate peripheral circulatory status via the perfusion index. In this prospective cohort study, we will examine the correlation between these two parameters and perioperative adverse events.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Adult Patients After Cardiac Surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Blood Pressure Variability and Perfusion Index | Other | All patients in this cohort will undergo invasive hemodynamic monitoring and noninvasive pulse oximetry, postoperative 24-hour blood pressure variability (from minute-to-minute invasive arterial pressure data) and perfusion index (from half-hourly recordings) were obtained through these monitoring modalities. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of the composite endpoint of adverse events within 30 days postoperatively | Total incidence of death, stroke, perioperative myocardial infarction, infection, reoperation, and continuous renal replacement therapy. Diagnostic criteria: Stroke was characterized by a new focal deficit associated with a compatible image on computed tomography. Perioperative myocardial infarction was diagnosed when cardiac troponin I shows an acute change with at least one value exceeding the 99th percentile upper reference limit, along with one of the following: new pathologic Q waves, imaging evidence of coronary artery occlusion, or imaging evidence of new loss of viable myocardium. Infection was considered if one of the following diagnoses was made by an Infectious Disease specialist who followed specific protocols: 1) Pneumonia; 2) Catheter related blood stream infection; 3) Sternal wound infection or osteomyelitis. | Within 30 days after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of low cardiac output syndrome within 30 days postoperatively. | Diagnostic criteria: Cardiac index < 2.0 L/min/m². | Within 30 days after surgery |
| Incidence of acute kidney injury within 30 days postoperatively. |
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Inclusion Criteria:
Age at surgery ≥ 18 years
Exclusion Criteria:
Patients with severe peripheral vascular disease in the arm used for noninvasive pulse oximetry monitoring
Patients not undergoing invasive hemodynamic monitoring â‘¢ Patients requiring preoperative or intraoperative support with IABP or ECMO
Patients expected to have incomplete postoperative monitoring data or a monitoring duration of less than 12 hours
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Adult patients undergoing cardiac surgery at Beijing Anzhen Hospital, Capital Medical University
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nan Liu Director of the Center for Cardiac Intensive Care, MD, PhD | Contact | +8613370103573 | ln9102@126.com |
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Diagnostic criteria are based on the KDIGO guidelines.
| Within 30 days after surgery |
| Incidence of acute respiratory distress syndrome within 30 days postoperatively | Diagnostic criteria are based on the 2012 Berlin definition of ARDS. | Within 30 days after surgery |
| Incidence of new-onset atrial arrhythmias within 30 days postoperatively. | Diagnostic criteria: atrial fibrillation or atrial flutter lasting more than 1 hour on continuous electrocardiographic monitoring, requiring pharmacological or electrical cardioversion. | Within 30 days after surgery |
| Incidence of prolonged ventilation (>24 hours) within 30 days postoperatively. | Within 30 days after surgery |
| Length of intensive care unit stay | Within 30 days after surgery |