Futier E, et al. - This article was written with the objective to assess whether an individualized blood pressure management strategy tailored to individual patient physiology could decrease postoperative organ dysfunction. Among patients predominantly undergoing abdominal surgery who were at increased postoperative risk, management targeting an individualized systolic blood pressure, compared with standard management, decreased the risk of postoperative organ dysfunction.

Methods

• For this research, they designed INPRESS (Intraoperative Norepinephrine to Control Arterial Pressure) study.
• This study was a multicenter, randomized, parallel-group clinical trial.
• This study was conducted in 9 French university and nonuniversity hospitals.
• Adult patients (n = 298) at increased risk of postoperative complications with a preoperative acute kidney injury risk index of class III or higher (indicating moderate to high risk of postoperative kidney injury) undergoing major surgery lasting 2 hours or longer under general anesthesia were selected from December 4, 2012, through August 28, 2016 (last follow-up, September 28, 2016).

Results

• Total 298 patients were randomized in this study.
• Among these 298 patients, 292 patients completed the trial (mean [SD] age, 70 [7] years; 44 [15.1%] women) and were incorporated into the modified intention-to-treat analysis.
• The primary outcome event occurred in 56 of 147 patients (38.1%) assigned to the individualized treatment strategy vs 75 of 145 patients (51.7%) assigned to the standard treatment strategy (relative risk, 0.73; 95% CI, 0.56 to 0.94; P = .02; absolute risk difference, -14%, 95% CI, -25% to -2%).
• 68 patients (46.3%) in the individualized treatment group and 92 (63.4%) in the standard treatment group had postoperative organ dysfunction by day 30 (adjusted hazard ratio, 0.66; 95% CI, 0.52 to 0.84; P = .001).
• No significant between-group differences were seen in severe adverse events or 1 month mortality.