Background: Intraoperative hypotension might contribute to the development of postoperative delirium through inadequate cerebral perfusion. However, evidence regarding the association between intraoperative hypotension and postoperative delirium is equivocal. Therefore, the hypothesis that intraoperative hypotension is associated with postoperative delirium in patients older than 70 yr having elective noncardiac surgery was tested . Methods: This was a retrospective cohort analysis of patients older than 70 yr who underwent elective noncardiac surgery in a single tertiary academic center between 2020 and 2021. Intraoperative hypotension was quantified as the area under a mean arterial pressure (MAP) threshold of 65 mmHg. Postoperative delirium was defined as a collapsed composite outcome including a positive 4 A’s test during the initial 2 postoperative days, and/or delirium identification using the Chart-based Delirium Identification Instrument. The association between hypotension and postoperative delirium was assessed using multivariable logistic regression, adjusting for potential confounding variables. Several sensitivity analyses were performed using similar regression models. Results: In total, 2,352 patients were included (median age, 76 yr; 1,112 [47%] women; 1,166 [50%] American Society of Anesthesiologists Physical Status III or greater; 698 [31%] having high-risk surgeries). The median [interquartile range] intraoperative area under the curve below a threshold of MAP less than 65 mmHg was 28 [0, 103] mmHg · min. The overall incidence of postoperative delirium was 14% (327 of 2,352). After adjustment for potential confounding variables, hypotension was not associated with postoperative delirium. Compared to the first quartile of area under the curve below a threshold of MAP less than 65 mmHg, patients in the second, third, and fourth quartiles did not have more postoperative delirium, with adjusted odds ratios of 0.94 (95% CI, 0.64 to 1.36; P = 0.73), 0.95 (95% CI, 0.66 to 1.36; P = 0.78), and 0.95 (95% CI, 0.65 to 1.36; P = 0.78), respectively. Intraoperative hypotension was also not associated with postoperative delirium in any of the sensitivity and subgroup analyses performed. Conclusions: To the extent of hypotension observed in our cohort, our results suggest that intraoperative hypotension is not associated with postoperative delirium in elderly patients having elective noncardiac surgery. Editor’s Perspective: What We Already Know about This Topic: What This Article Tells Us That Is New:

Knowledge of the outcomes of critically ill patients is crucial for health and government officials who are planning how to address local outbreaks. The factors associated with outcomes of critically ill patients with coronavirus disease 2019 (Covid-19) who required treatment in an intensive care unit (ICU) are yet to be determined. Methods: This was a retrospective registry-based case series of patients with laboratory-confirmed SARS-CoV-2 who were referred for ICU admission and treated in the ICUs of the 13 participating centers in Israel between 5 March and 27 April 2020. Demographic and clinical data including clinical management were collected and subjected to a multivariable analysis; primary outcome was mortality. Results: This study included 156 patients (median age = 72 years (range = 22–97 years)); 69% (108 of 156) were male. Eighty-nine percent (139 of 156) of patients had at least one comorbidity. One hundred three patients (66%) required invasive mechanical ventilation. As of 8 May 2020, the median length of stay in the ICU was 10 days (range = 0–37 days). The overall mortality rate was 56%; a multivariable regression model revealed that increasing age (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), the presence of sepsis (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), and a shorter ICU stay(OR = 0.90 for each day, 95% CI = 0.84–0.96) were independent prognostic factors. Conclusions: In our case series, we found lower mortality rates than those in exhausted health systems. The results of our multivariable model suggest that further evaluation is needed of antiviral and antibacterial agents in the treatment of sepsis and secondary infection.

Introduction: Intra-abdominal hypertension and the resulting abdominal compartment syndrome are serious complications of severely ill patients. Diagnosis requires an intra-abdominal pressure (IAP) measurement, which is currently cumbersome and underused. We aimed to test the accuracy of a novel continuous IAP monitor. Methods: Adults having laparoscopic surgery and requiring urinary catheter intra-operatively were recruited to this single-arm validation study. IAP measurements using the novel monitor and a gold-standard foley manometer were compared. After anesthesia induction, a pneumoperitoneum was induced through a laparoscopic insufflator, and five randomly pre-defined pressures (between 5 and 25 mmHg) were achieved and simultaneously measured via both methods in each participant. Measurements were compared using Bland–Altman analysis. Results: In total, 29 participants completed the study and provided 144 distinct pairs of pressure measurements that were analyzed. A positive correlation between the two methods was found (R² = 0.93). There was good agreement between the methods, with a mean bias (95% CI) of −0.4 (−0.6, −0.1) mmHg and a standard deviation of 1.3 mmHg, which was statistically significant but of no clinical importance. The limits of agreement (where 95% of the differences are expected to fall) were −2.9 and 2.2 mmHg. The proportional error was statistically insignificant (p = 0.85), suggesting a constant agreement between the methods across the range of values tested. The percentage error was 10.7%. Conclusions: Continuous IAP measurements using the novel monitor performed well in the clinical setup of controlled intra-abdominal hypertension across the evaluated range of pressures. Further studies should expand the range to more pathological values.