PeriOperative Quality Initiative (POQI) international consensus statement on perioperative arterial pressure management
POQI · 2024 · international
Source and licence
- Authors
- Bernd Saugel, Nick Fletcher, Tong J Gan et al.
- Title
- PeriOperative Quality Initiative (POQI) international consensus statement on perioperative arterial pressure management
- Journal
- BJA: British Journal of Anaesthesia, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11282474
Licence statement of the original publication
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Methods
- Consensus recommendation 1We recommend keeping intraoperative mean arterial pressure ≥60 mm Hg in at-risk patients.Agreement (%): 97
- Consensus recommendation 2We recommend increasing mean arterial pressure targets when venous or compartment pressures are elevated.Agreement (%): 94
- Consensus recommendation 3We recommend that treatment of hypotension be based on presumed underlying causes including vasodilation, hypovolaemia, bradycardia, and low cardiac output.Agreement (%): 100
- Consensus recommendation 4If intraoperative hypertension is treated, we recommend caution to avoid hypotension.Agreement (%): 100
Consensus statements and recommendations
- Consensus statement 1Intraoperative mean arterial pressures <60–70 mm Hg or systolic arterial pressures <90–100 mm Hg are associated with acute kidney injury, myocardial injury, myocardial infarction, and death. Injury is a function of hypotension severity and durationhigh-quality evidence
- Consensus statement 2In general surgery, there is no association between intraoperative systolic arterial pressures between 120 and 200 mm Hg and acute kidney injury and myocardial injurylow-quality evidence
- Consensus statement 3Continuous intraoperative arterial pressure monitoring helps clinicians reduce the severity and duration of hypotension compared to intermittent arterial pressure monitoringhigh-quality evidence
- Consensus statement 4Postoperative hypotension is often unrecognised and might be more important than intraoperative hypotension because it is often prolonged (moderate-quality evidence). However, postoperative hypotensive harm thresholds remain unclear.
Abstract
Arterial pressure monitoring and management are mainstays of haemodynamic therapy in patients having surgery. This article presents updated consensus statements and recommendations on perioperative arterial pressure management developed during the 11th POQI PeriOperative Quality Initiative (POQI) consensus conference held in London, UK, on June 4–6, 2023, which included a diverse group of international experts. Based on a modified Delphi approach, we recommend keeping intraoperative mean arterial pressure ≥60 mm Hg in at-risk patients. We further recommend increasing mean arterial pressure targets when venous or compartment pressures are elevated and treating hypotension based on presumed underlying causes. When intraoperative hypertension is treated, we recommend doing so carefully to avoid hypotension. Clinicians should consider continuous intraoperative arterial pressure monitoring as it can help reduce the severity and duration of hypotension compared to intermittent arterial pressure monitoring. Postoperative hypotension is often unrecognised and might be more important than intraoperative hypotension because it is often prolonged and untreated. Future research should focus on identifying patient-specific and organ-specific hypotension harm thresholds and optimal treatment strategies for intraoperative hypotension including choice of vasopressors. Research is also needed to guide monitoring and management strategies for recognising, preventing, and treating postoperative hypotension.
Contents of the original publication
The section headings of the original.
- Methods
- Consensus statements and recommendations
- Recommendations for research
- Are there organ-specific hypotensive harm thresholds for the kidney, heart, intestines, liver, and brain? Are hypotensive harm thresholds altered by perioperative factors? What arterial pressure threshold minimises risk to all organs?
- Do various causes of hypotension (vasodilation, hypovolaemia, bradycardia, or low cardiac output) affect the association between hypotension and organ injury?
- Do hypotensive harm thresholds differ with oscillometric vs intraarterial arterial pressure measurements?
- Do predictive algorithms or closed-loop control prevent organ injury?
- Which vasopressor best protects organs from hypotensive injury?
- Are intraoperative or postoperative hypotension associated with acute and long-term cognitive impairment?
- Does continuous ward vital sign monitoring allow clinicians to intervene in ways that improve patient outcomes?
- Strengths and limitations
- Conclusions
- Supplementary data
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