Haemodynamics, fluids & transfusion
Blood pressure thresholds for the administration of balanced crystalloids and the effect on intra-operative hypotension: A proof-of-concept causal inference analysis featuring idealised dynamic treatment regimens
Authors' conclusion
Using modern causal inference methods, we demonstrated the clinical utility of idealised DTRs to study the impact of time-dependent haemodynamic management on the incidence of intra-operative hypotension in idealised settings.
Study context
- Population
- Patients undergoing elective surgery under GA, tertiary institution in South Korea, January 2011 to December 2020 (INSPIRE dataset)
- Participants
- 23,305 patients
- Exposure
- Dynamic treatment regimens (DTRs) giving 250 ml balanced crystalloids when MAP drops below 60, 65, 70 or 75 mmHg
- Outcome
- Intra-operative hypotension (MAP below 65 mmHg averaged in 15-min windows)
Methodological detailscausal inference methods, dynamic treatment regimens, single-centre
- Causal inference methods
- Dynamic treatment regimens
- Single-centre
Main finding
As reported in the abstract
- Clinically similar incidences of intra-operative hypotension across DTRs for surgeries shorter than 2 h
- For longer surgeries, DTRs with early fluid administration reduced hypotension towards the end of surgery by more than 4%
- Hypothetical (idealised) DTRs
Observational data: associations, not effects.
Original publication
Blood pressure thresholds for the administration of balanced crystalloids and the effect on intra-operative hypotension: A proof-of-concept causal inference analysis featuring idealised dynamic treatment regimens. Eur J Anaesthesiol. Published 2 February 2026. doi:10.
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