{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:34:35Z","timestamp":1784565275854,"version":"3.55.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T00:00:00Z","timestamp":1718582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Hypotension is a risk factor for postoperative complications, but evidence from randomized trials does not support that a higher blood pressure target always leads to optimized outcomes. The heterogeneity of underlying hemodynamics during hypotension may contribute to these contradictory results. Exploring the subtypes of hypotension can enable optimal management of intraoperative hypotension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a prospective, observational pilot study. Patients who were\u2009\u2265\u200945\u2009years old and scheduled to undergo moderate-to-high-risk noncardiac surgery were enrolled in this study. The primary objective of this pilot study was to investigate the frequency and distribution of perioperative hypotension and its subtypes (hypotension with or without cardiac output reduction). The exposure of hypotension and its subtypes in patients with and without myocardial or acute kidney injury were also explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty patients were included in the analysis. 83% (50\/60) of the patients experienced perioperative hypotension. The median duration of hypotension for each patient was 8.0 [interquartile range, 3.1\u201323.3] minutes. Reduced cardiac output was present during 77% of the hypotension duration. Patients suffering from postoperative myocardial or acute kidney injury displayed longer duration and more extensive exposure in all hypotension subtypes. However, the percentage of different hypotension subtypes did not differ in patients with or without postoperative myocardial or acute kidney injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Perioperative hypotension was frequently accompanied by cardiac output reduction in moderate-to-high-risk noncardiac surgical patients. However, due to the pilot nature of this study, the relationship between hypotension subtypes and postoperative myocardial or acute kidney injury still needs further exploration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.chictr.org.cn\/showprojEN.html?proj=134260<\/jats:ext-link>, CTR2200055929.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1358067","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T04:49:25Z","timestamp":1718599765000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The exploration of perioperative hypotension subtypes: a prospective, single cohort, observational pilot study"],"prefix":"10.3389","volume":"11","author":[{"given":"Xu","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanjia","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengjia","family":"Kou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongxing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiulan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhishuang","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyan","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihui","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanyan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenqi","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1097\/ALN.0000000000003610","article-title":"Perioperative blood pressure management","volume":"134","author":"Saugel","year":"2021","journal-title":"Anesthesiology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/j.bja.2022.01.012","article-title":"Hypotension as a marker or mediator of perioperative organ injury: a narrative review","volume":"128","author":"Ackland","year":"2022","journal-title":"Br J Anaesth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s00134-018-5224-7","article-title":"Perioperative myocardial injury and the contribution of hypotension","volume":"44","author":"Sessler","year":"2018","journal-title":"Intensive Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1936","DOI":"10.1213\/ANE.0000000000002560","article-title":"A prospective international multicentre cohort study of intraoperative heart rate and systolic blood pressure and myocardial injury after noncardiac surgery: results of the VISION study","volume":"126","author":"Abbott","year":"2018","journal-title":"Anesth Analg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1097\/ALN.0000000000001432","article-title":"Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis","volume":"126","author":"Salmasi","year":"2017","journal-title":"Anesthesiology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1097\/ALN.0000000000001985","article-title":"Period-dependent associations between hypotension during and for four days after noncardiac surgery and a composite of myocardial infarction and death: a substudy of the POISE-2 trial","volume":"128","author":"Sessler","year":"2018","journal-title":"Anesthesiology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1097\/ALN.0000000000000922","article-title":"Association between intraoperative hypotension and myocardial injury after vascular surgery","volume":"124","author":"Van Waes","year":"2016","journal-title":"Anesthesiology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.bja.2022.03.027","article-title":"Intraoperative hypotension is associated with persistent acute kidney disease after noncardiac surgery: a multicentre cohort study","volume":"129","author":"Shaw","year":"2022","journal-title":"Br J Anaesth"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1097\/ALN.0000000000000765","article-title":"Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery","volume":"123","author":"Sun","year":"2015","journal-title":"Anesthesiology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1097\/ALN.0b013e3182a10e26","article-title":"Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension","volume":"119","author":"Walsh","year":"2013","journal-title":"Anesthesiology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1097\/ALN.0b013e3182472320","article-title":"Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study","volume":"116","author":"Bijker","year":"2012","journal-title":"Anesthesiology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1016\/S0140-6736(08)60601-7","article-title":"Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial","volume":"371","author":"Devereaux","year":"2008","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1097\/SLA.0000000000001607","article-title":"Association between intraoperative low blood pressure and development of surgical site infection after colorectal surgery","volume":"264","author":"Babazade","year":"2016","journal-title":"Ann Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1213\/ANE.0000000000001526","article-title":"The association between mild intraoperative hypotension and stroke in general surgery patients","volume":"123","author":"Hsieh","year":"2016","journal-title":"Anesth Analg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1001\/jama.2017.14172","article-title":"Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial","volume":"318","author":"Futier","year":"2017","journal-title":"JAMA"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1016\/j.bja.2021.06.048","article-title":"Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review","volume":"127","author":"Meng","year":"2021","journal-title":"Br J Anaesth"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.bja.2022.07.056","article-title":"Endotypes of intraoperative hypotension during major abdominal surgery: a retrospective machine learning analysis of an observational cohort study","volume":"130","author":"Kouz","year":"2023","journal-title":"Br J Anaesth"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1186\/s13054-018-2171-1","article-title":"The meaning of blood pressure","volume":"22","author":"Magder","year":"2018","journal-title":"Crit Care"},{"key":"ref19","volume-title":"Physiology, cardiac output. [updated 2023 Jul 17]. In: StatPearls [internet]","author":"King","year":"2024"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1097\/ALN.0000000000000872","article-title":"Cardiac output and cerebral blood flow: the integrated regulation of brain perfusion in adult humans","volume":"123","author":"Meng","year":"2015","journal-title":"Anesthesiology"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2181","DOI":"10.1001\/jama.2014.5305","article-title":"Effect of a perioperative, cardiac output\u2013guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review","volume":"311","author":"Pearse","year":"2014","journal-title":"JAMA"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2383","DOI":"10.1093\/eurheartj\/ehu282","article-title":"2014 ESC\/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA)","volume":"35","author":"Kristensen","year":"2014","journal-title":"Eur Heart J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1097\/ALN.0000000000002300","article-title":"Machine-learning algorithm to predict hypotension based on high-fidelity arterial pressure waveform analysis","volume":"129","author":"Hatib","year":"2018","journal-title":"Anesthesiology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"109961","DOI":"10.1016\/j.jclinane.2020.109961","article-title":"The incidence of intraoperative hypotension in moderate to high risk patients undergoing non-cardiac surgery: a retrospective multicenter observational analysis","volume":"66","author":"Shah","year":"2020","journal-title":"J Clin Anesth"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e102","DOI":"10.1016\/j.bja.2021.06.024","article-title":"Association between intraoperative mean arterial pressure and postoperative complications is independent of cardiac index in patients undergoing noncardiac surgery","volume":"127","author":"Maheshwari","year":"2021","journal-title":"Br J Anaesth"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1213\/ANE.0000000000005489","article-title":"Association between cerebral desaturation and postoperative delirium in thoracotomy with one-lung ventilation: a prospective cohort study","volume":"133","author":"Cui","year":"2021","journal-title":"Anesth Analg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/EJA.0000000000000118","article-title":"Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European perioperative clinical outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures","volume":"32","author":"Jammer","year":"2015","journal-title":"Eur J Anaesthesiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1186\/cc11454","article-title":"Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1)","volume":"17","author":"Kellum","year":"2013","journal-title":"Crit Care"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"153","DOI":"10.2147\/CLEP.S146397","article-title":"Guidance for using pilot studies to inform the design of intervention trials with continuous outcomes","volume":"10","author":"Bell","year":"2018","journal-title":"Clin Epidemiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/j.bja.2019.01.019","article-title":"Perioperative quality initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery","volume":"122","author":"Mcevoy","year":"2019","journal-title":"Br J Anaesth"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1726","DOI":"10.1056\/NEJMra1208943","article-title":"Circulatory shock","volume":"369","author":"Vincent","year":"2013","journal-title":"N Engl J Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1093\/bja\/aeh171","article-title":"The heart and circulation in severe sepsis","volume":"93","author":"Young","year":"2004","journal-title":"BJA"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016","volume":"43","author":"Rhodes","year":"2017","journal-title":"Intensive Care Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1111\/anae.14416","article-title":"The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis","volume":"73","author":"Maheshwari","year":"2018","journal-title":"Anaesthesia"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s10877-021-00653-9","article-title":"Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study","volume":"36","author":"Saugel","year":"2022","journal-title":"J Clin Monit Comput"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1093\/bja\/aes416","article-title":"Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized, clinical trial","volume":"110","author":"M\u00f6ller Petrun","year":"2013","journal-title":"Br J Anaesth"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1001\/jama.2017.4360","article-title":"Association of Postoperative High-Sensitivity Troponin Levels with Myocardial Injury and 30-day mortality among patients undergoing noncardiac surgery","volume":"317","author":"Devereaux","year":"2017","journal-title":"JAMA"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1097\/ALN.0000000000003048","article-title":"Associations of intraoperative radial arterial systolic, diastolic, mean, and pulse pressures with myocardial and acute kidney injury after noncardiac surgery: a retrospective cohort analysis","volume":"132","author":"Ahuja","year":"2020","journal-title":"Anesthesiology"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e1916921","DOI":"10.1001\/jamanetworkopen.2019.16921","article-title":"Risk stratification for postoperative acute kidney injury in major noncardiac surgery using preoperative and intraoperative data","volume":"2","author":"Lei","year":"2019","journal-title":"JAMA Netw Open"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1097\/ALN.0000000000000022","article-title":"Perioperative organ injury","volume":"119","author":"Bartels","year":"2013","journal-title":"Anesthesiology"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.bja.2020.03.013","article-title":"Continuous noninvasive pulse wave analysis using finger cuff technologies for arterial blood pressure and cardiac output monitoring in perioperative and intensive care medicine: a systematic review and meta-analysis","volume":"125","author":"Saugel","year":"2020","journal-title":"Br J Anaesth"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1097\/ALN.0000000000003553","article-title":"Pulse wave analysis to estimate cardiac output","volume":"134","author":"Kouz","year":"2021","journal-title":"Anesthesiology"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1097\/ALN.0000000000003483","article-title":"Technological assessment and objective evaluation of minimally invasive and noninvasive cardiac output monitoring systems","volume":"133","author":"Saugel","year":"2020","journal-title":"Anesthesiology"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1007\/s10877-017-0027-x","article-title":"A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients","volume":"32","author":"Wagner","year":"2018","journal-title":"J Clin Monit Comput"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1358067\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T04:49:31Z","timestamp":1718599771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1358067\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,17]]},"references-count":44,"alternative-id":["10.3389\/fmed.2024.1358067"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1358067","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,17]]},"article-number":"1358067"}}