IMPROVE
Trial question
What is the role of personalized intraoperative BP management in patients undergoing major noncardiac surgery?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 328
328 patients (122 female, 206 male).
Inclusion criteria: patients undergoing major noncardiac surgery.
Key exclusion criteria: history of cerebrovascular events; dementia; kidney transplantation; requirement of dialysis; scheduled for emergency cardiac, vascular, transplant, or neurosurgery.
Interventions
N=166 personalized BP management (maintaining intraoperative mean arterial pressure above preoperative baseline mean arterial pressure from automated 24-hour BP monitoring).
N=162 routine BP management (maintaining mean arterial pressure above 65 mmHg).
Primary outcome
Rate of neurocognitive disorders between postoperative days 3 and 7
12%
14%
14.0 %
10.5 %
7.0 %
3.5 %
0.0 %
Personalized blood pressure
management
Routine blood pressure
management
No significant
difference ↔
No significant difference in the rate of neurocognitive disorders between postoperative days 3 and 7 (12% vs. 14%; OR 0.84, 95% CI 0.4 to 1.75).
Secondary outcomes
No significant difference in delayed neurocognitive recovery (12% vs. 12%; OR 0.99, 99% CI 0.45 to 2.17).
No significant difference in delirium (1% vs. 3%; OR 0.5, 95% CI 0.04 to 3.53).
No significant difference in the rate of death at postoperative day 90 (3% vs. 4%; OR 1.15, 95% CI 0.29 to 4.86).
Safety outcomes
No significant difference in postoperative complications.
Conclusion
In patients undergoing major noncardiac surgery, personalized BP management was not superior to routine BP management with respect to the rate of neurocognitive disorders between postoperative days 3 and 7.
Reference
Julia Y Nicklas, Alina Bergholz, Francesco Däke et al. Personalised blood pressure management during major noncardiac surgery and postoperative neurocognitive disorders: a randomised trial. BJA Open. 2024 Jul 1:11:100294.
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