General Surgery
The Challenge – Cumulative Micro-tissue Damage:
Patient blood pressure volatility during general surgery can be unexpected and varied. Extremes of blood pressure even for short periods of time may result in increased morbidity and mortality.
Evidence – Journal Anesthesia & Analgesia study by Monk, et al., “Anesthetic Management and One-Year Mortality After Noncardiac Surgery” concluded that when systolic blood pressure falls to below 80 mm Hg. for 1 minute, mortality increases by 3.6%. The damage appears to be cumulative. A systolic pressure under 80 mm Hg. for 3 min results in an increased mortality over 10%.
Our Solution – Targeted Bi-Directional Blood Pressure Control:
The AutoPress is intended to reduce the occurrences of bi-directional blood pressure volatility during general surgery by responding to changes in the slope of BP and providing micro-doses of the appropriate medication required to return BP to the desired target level.
Head Trauma/Brain Surgery
The Challenge – Maintaining Delicate Cerebral Blood Flow:
Autoregulation of cerebral blood flow is impaired and becomes pressure passive with any injury to the brain. It is critical to maintain stable blood pressure to preserve cerebral blood flow in the presence of neurological injury, tumor, trauma and surgery.
The Evidence – Journal of Neurosurgery study by E. C. Jünger, et al. “Cerebral autoregulation following minor head injury” indicates that a significant number of patients with minor head injury may have impaired cerebral autoregulation and may be at increased risk for secondary ischemic neuronal damage.
Our Solution – Precise Blood Pressure Control:
AutoPress operators can set a target blood pressure and thus help to maintain cerebral perfusion and help to compensate for poorly functioning or absent cerebral autoregulation in head-injured patients.
Stroke/CVA
The Challenge – Timely blood pressure management is essential for ischemic stroke patients: There is a demonstrated U-shaped relationship between blood pressure and death in stroke patients. Optimal initial systolic BP is in the range of 140 to 160 mm Hg. Results support the need for higher BP immediately after stroke.
The Evidence – Journal of the American Medical Association randomized controlled trial led by Jiang He, et al. “Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial.”
Our Solution – Rapid, Measured, Stable Blood Pressure Control: It is very difficult to control systolic blood pressure so accurately, in the study listed mortality increased with systolic pressures over 160 and below 140. The AutoPress is able to deliver precise vasoactive medications that can help perform this difficult task.
Spinal Cord Injury
The Challenge – Spinal cord injury guidelines recommend mean arterial pressures above 85 mm Hg:
There is a positive correlation between mean arterial pressure values and neurological recovery from traumatic spinal cord injury.
Evidence – Journal of World Neurosurgery study by Joshua Stephen Catapano, MD, et al. “Higher Mean Arterial Pressure Values Correlate With Neurological Improvement in Patients With Initially Complete Spinal Cord Injuries.”
Our Solution – Targeted Mean Arterial Pressure:
The AutoPress precisely delivers vasopressor doses in response to decreases in mean arterial blood pressure in order to maintain spinal cord perfusion pressures.
Preeclampsia /PIH
The Challenge – Preeclampsia/eclampsia markedly elevates the risk for intracranial hemorrhage: A paradigm shift is needed toward aggressive antihypertensive therapy for this patient population.
The Evidence – Journal of Obstetrics & Gynecology study by James N. Martin, Jr., et al. “Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure” concludes that the focus of treatment should be the urgent control of systolic blood pressure less than 150mm Hg.
Our Solution – Control of High Blood Pressure Extremes:The AutoPress monitors and reacts to keep systolic blood pressure below dangerous levels.
Open Heart Surgery
The Challenge – Hypotension and hypertension in cardiac surgery patients are associated with adverse clinical outcomes: Postoperative hypertension is strongly associated with adverse outcomes, including acute kidney injury as well as death, in patients following cardiac surgery. Hypotension is a frequent complication in the intensive care unit after adult cardiac surgery.
The Evidence – Journal of Cardiothoracic and Vascular Anesthesia study by Felix Balzer, MD, MSc, et al. “High Postoperative Blood Pressure After Cardiac Surgery Is Associated With Acute Kidney Injury and Death” concludes that tight hypertension control reduces serious adverse outcomes in cardiac surgery patients. Also, World Journal of Critical Care Medicine found, “Hypotension after intensive care unit drop-off in adult cardiac surgery patients”
Our Solution – Perioperative Blood Pressure Control:
The AutoPress is transportable through the perioperative continuum of care where it can be used to control the frequent hypotensive and hypertensive episodes experienced by cardiac surgical patients.
Carotid Endarterectomy
The Challenge – Treatment of hemodynamic instability for patients after carotid endarterectomy: Significant postoperative hypotension is associated with increased perioperative mortality, cardiac, or stroke complications, as well as increased 1-year death or stroke following carotid endarterectomy.
The Evidence – Journal of Vascular Surgery study by Tze-Woei Tan, MD, et al. “The need for treatment of hemodynamic instability following carotid endarterectomy is associated with increased perioperative and 1-year morbidity and mortality”
Our Solution – Control of Blood Pressure Extremes: The AutoPress monitors and reacts and intervenes to minimize the potential for hypertension or hypotension.
Ortho/Spine Surgery
The Challenge – Perioperative myocardial damage in orthopedic surgery: Analysis shows that risk for elevation of troponin increased with orthopedic surgery or intraoperative hypotension; increasing duration of hypotension strongly predictive of myocardial necrosis.
The Evidence – Journal Heart study by Richard F. Alcock, et al. “Perioperative myocardial necrosis in patients at high cardiovascular risk undergoing elective non-cardiac surgery.”
Our Solution – Targeted Blood Pressure Control: The AutoPress is intended to reduce the occurrence of blood pressure volatility risk associated with myocardial necrosis and troponin leak.
