TY - JOUR
T1 - Carbon Dioxide, Blood Pressure, and Perioperative Stroke
T2 - A Retrospective Case-Control Study
AU - Vlisides, Phillip E.
AU - Mentz, Graciela
AU - Leis, Aleda M.
AU - Colquhoun, Douglas
AU - McBride, Jonathon
AU - Naik, Bhiken I.
AU - Dunn, Lauren K.
AU - Aziz, Michael
AU - Vagnerova, Kamila
AU - Christensen, Clint
AU - Pace, Nathan L.
AU - Horn, Jeffrey
AU - Cummings, Kenneth
AU - Cywinski, Jacek
AU - Akkermans, Annemarie
AU - Kheterpal, Sachin
AU - Moore, Laurel E.
AU - Mashour, George A.
N1 - Funding Information:
Supported by the National Institutes of Health, Bethesda, Maryland, grants L30GM116069, K23GM126317 (Dr. Vlisides), and K08HL159327 (Dr. Colquhoun). Funding was also provided by departmental and institutional resources at each contributing site. In addition, partial funding to support underlying electronic health record data collection into the Multicenter Perioperative Outcomes Group registry was provided by Blue Cross Blue Shield of Michigan/Blue Care Network (Detroit, Michigan) as part of the Blue Cross Blue Shield of Michigan/Blue Care Network Value Partnerships program. Although Blue Cross Blue Shield of Michigan/Blue Care Network and the Multicenter Perioperative Outcomes Group work collaboratively, the opinions, beliefs and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of Blue Cross Blue Shield of Michigan/Blue Care Network or any of its employees.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Background: The relationship between intraoperative physiology and postoperative stroke is incompletely understood. Preliminary data suggest that either hypo- or hypercapnia coupled with reduced cerebrovascular inflow (e.g., due to hypotension) can lead to ischemia. This study tested the hypothesis that the combination of intraoperative hypotension and either hypo- or hypercarbia is associated with postoperative ischemic stroke. Methods: We conducted a retrospective, case-control study via the Multicenter Perioperative Outcomes Group. Noncardiac, nonintracranial, and nonmajor vascular surgical cases (18 yr or older) were extracted from five major academic centers between January 2004 and December 2015. Ischemic stroke cases were identified via manual chart review and matched to controls (1:4). Time and reduction below key mean arterial blood pressure thresholds (less than 55 mmHg, less than 60 mmHg, less than 65 mmHg) and outside of specific end-tidal carbon dioxide thresholds (30 mmHg or less, 35 mmHg or less, 45 mmHg or greater) were calculated based on total area under the curve. The association between stroke and total area under the curve values was then tested while adjusting for relevant confounders. Results: In total, 1,244,881 cases were analyzed. Among the cases that screened positive for stroke (n = 1,702), 126 were confirmed and successfully matched with 500 corresponding controls. Total area under the curve was significantly associated with stroke for all thresholds tested, with the strongest combination observed with mean arterial pressure less than 55 mmHg (adjusted odds ratio per 10 mmHg-min, 1.17 [95% CI, 1.10 to 1.23], P < 0.0001) and end-tidal carbon dioxide 45 mmHg or greater (adjusted odds ratio per 10 mmHg-min, 1.11 [95% CI, 1.10 to 1.11], P < 0.0001). There was no interaction effect observed between blood pressure and carbon dioxide. Conclusions: Intraoperative hypotension and carbon dioxide dysregulation may each independently increase postoperative stroke risk.
AB - Background: The relationship between intraoperative physiology and postoperative stroke is incompletely understood. Preliminary data suggest that either hypo- or hypercapnia coupled with reduced cerebrovascular inflow (e.g., due to hypotension) can lead to ischemia. This study tested the hypothesis that the combination of intraoperative hypotension and either hypo- or hypercarbia is associated with postoperative ischemic stroke. Methods: We conducted a retrospective, case-control study via the Multicenter Perioperative Outcomes Group. Noncardiac, nonintracranial, and nonmajor vascular surgical cases (18 yr or older) were extracted from five major academic centers between January 2004 and December 2015. Ischemic stroke cases were identified via manual chart review and matched to controls (1:4). Time and reduction below key mean arterial blood pressure thresholds (less than 55 mmHg, less than 60 mmHg, less than 65 mmHg) and outside of specific end-tidal carbon dioxide thresholds (30 mmHg or less, 35 mmHg or less, 45 mmHg or greater) were calculated based on total area under the curve. The association between stroke and total area under the curve values was then tested while adjusting for relevant confounders. Results: In total, 1,244,881 cases were analyzed. Among the cases that screened positive for stroke (n = 1,702), 126 were confirmed and successfully matched with 500 corresponding controls. Total area under the curve was significantly associated with stroke for all thresholds tested, with the strongest combination observed with mean arterial pressure less than 55 mmHg (adjusted odds ratio per 10 mmHg-min, 1.17 [95% CI, 1.10 to 1.23], P < 0.0001) and end-tidal carbon dioxide 45 mmHg or greater (adjusted odds ratio per 10 mmHg-min, 1.11 [95% CI, 1.10 to 1.11], P < 0.0001). There was no interaction effect observed between blood pressure and carbon dioxide. Conclusions: Intraoperative hypotension and carbon dioxide dysregulation may each independently increase postoperative stroke risk.
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U2 - 10.1097/ALN.0000000000004354
DO - 10.1097/ALN.0000000000004354
M3 - Article
C2 - 35960872
AN - SCOPUS:85138489985
SN - 0003-3022
VL - 137
SP - 434
EP - 445
JO - Anesthesiology
JF - Anesthesiology
IS - 4
ER -