Correspondence  |   October 2017
Intraoperative Mean Arterial Pressure Targets: Can Databases Give Us a Universally Valid “Magic Number” or Does Physiology Still Apply for the Individual Patient?
Author Notes
  • University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (B.S.). bernd.saugel@gmx.de; b.saugel@uke.de
  • (Accepted for publication June 30, 2017.)
    (Accepted for publication June 30, 2017.)×
Article Information
Correspondence
Correspondence   |   October 2017
Intraoperative Mean Arterial Pressure Targets: Can Databases Give Us a Universally Valid “Magic Number” or Does Physiology Still Apply for the Individual Patient?
Anesthesiology 10 2017, Vol.127, 725-726. doi:10.1097/ALN.0000000000001810
Anesthesiology 10 2017, Vol.127, 725-726. doi:10.1097/ALN.0000000000001810
With great interest we read the article by Salmasi et al.1  reporting the results of a database study investigating the relationship between acute postoperative kidney and myocardial injury and intraoperative hypotension (IOH) either defined as a reduction from baseline mean arterial pressure (MAP) or absolute MAP thresholds. The authors, again, need to be commended for providing another piece of the puzzle on how to better define and understand IOH using their impressive database. In line with other data,2  this study demonstrates a gradually increasing risk for both kidney and myocardial injury for longer exposure beneath certain MAP thresholds (both absolute or relative) and therefore adds to the evidence that IOH-associated organ failure is a function of hypotension and time.3  Yet, the main new question this study aimed to answer was whether a definition of IOH should be based on absolute MAP thresholds or on a relative decline from baseline MAP. The authors’ conclusion seems to make our daily practice as anesthesiologists very easy: “a strategy aimed at maintaining MAP above 65 mmHg appears to be as good as one based on the percentage reduction from baseline.”1 
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