Evidence map›Paper›PMID 37295123›Full record

ArticleJournal of clinical anesthesia2023

Incidence, severity and detection of blood pressure and heart rate perturbations in postoperative ward patients after noncardiac surgery.

Ashish K Khanna, Nathaniel S O'Connell, Sanchit Ahuja, Amit K Saha, Lynnette Harris, Bruce D Cusson, Ann Faris, Carolyn S Huffman, Saraschandra Vallabhajosyula, Clancy J Clark and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical anesthesia, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Trial
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

Ashish K KhannaDepartment of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA. Electronic address: akhanna@wakehealth.edu.
Nathaniel S O'ConnellDepartment of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address: N.Oconnell@wakehealth.edu.
Sanchit AhujaOutcomes Research Consortium, Cleveland, OH, USA; Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ahuja.sanchit@gmail.com.
Amit K SahaDepartment of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA. Electronic address: aksaha@wakehealth.edu.
Lynnette HarrisDepartment of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA. Electronic address: lcharris@wakehealth.edu.
Bruce D CussonDepartment of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address: bcusson@wakehealth.edu.
Ann FarisPerioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA. Electronic address: efaris@wakehealth.edu.
Carolyn S HuffmanPerioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA. Electronic address: cfhuffma@wakehealth.edu.
Saraschandra VallabhajosyulaPerioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address: svallabh@wakehealth.edu.
Clancy J ClarkDepartment of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address: cjclark@wakehealth.edu.
Scott SegalDepartment of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA. Electronic address: bsegal@wakehealth.edu.
Brian J WellsDepartment of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address: bjwells@wakehealth.edu.
Eric S KirkendallDepartment of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address: ekirkend@wakehealth.edu.
Daniel I SesslerDepartment of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ds@or.org.

Funding

Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
Development of quantitative tools to predict patients with difficult intubation to minimize treatment related complicationsR21EB029493 · NIBIB · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI NIAZI, MUHAMMAD KHALID KHAN, SEGAL, SCOTT · 2021 to 2023
$620k
NCATS NIH HHS UL1 TR001420NIBIB NIH HHS R21 EB029493
6 · The paper itself

Abstract

STUDY

objectiveWe sought to determine changes in continuous mean and systolic blood pressure and heart rate in a cohort of non-cardiac surgical patients recovering on the postoperative ward. Furthermore, we estimated the proportion of vital signs changes that would remain undetected with intermittent vital signs checks.

designRetrospective cohort.

settingPost-operative general ward. PATIENTS: 14,623 adults recovering from non-cardiac surgical procedures. INTERVENTIONS & MEASUREMENTS: Using a wireless, noninvasive monitor, we recorded postoperative blood pressure and heart rate at 15-s intervals and encouraged nursing intervention as clinically indicated. MAIN

results7% of our cohort of 14,623 patients spent >15 sustained minutes with a MAP <65 mmHg, and 23% had MAP <75 mmHg for 15 sustained minutes. Hypertension was more common, with 67% of patients spending at least 60 sustained minutes with MAP >110 mmHg. Systolic pressures <90 mmHg were present for 15 sustained minutes in about a fifth of all patients, and 40% of patients had pressures >160 mmHg sustained for 30 min. 40% of patients were tachycardic with heart rates >100 beats/min for at least continuous 15 min and 15% of patients were bradycardic at a threshold of <50 beats/min for 5 sustained minutes. Conventional vital sign assessments at 4-h intervals would have missed 54% of mean pressure episodes <65 mmHg sustained >15 min, 20% of episodes of mean pressures >130 mmHg sustained >30 min, 36% of episodes of heart rate > 120 beats/min sustained <10 min, and 68% of episodes of heart rate sustained <40 beats per minute for >3 min.

conclusionsSubstantial hemodynamic disturbances persisted despite implementing continuous portable ward monitoring coupled with nursing alarms and interventions. A significant proportion of these changes would have gone undetected using traditional intermittent monitoring. Better understanding of effective responses to alarms and appropriate interventions on hospital wards remains necessary.

Indexed as

HospitalsVital SignsAdultBlood PressureHeart RateHumansIncidenceRetrospective StudiesBlood pressureContinuousHeart rateMonitoringVital signs

Identifiers

PMID37295123
PMCPMC11542488

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.