Hypotension Prediction Index based protocolized haemodynamic management reduces the incidence and duration of intraoperative hypotension in primary total hip arthroplasty: a single centre feasibility randomised blinded prospective interventional trial

Schneck, Emmanuel; Schulte, Dagmar; Habig, Lukas; Ruhrmann, Sophie; Edinger, Fabian; Markmann, Melanie; Habicher, Marit; Rickert, Markus; Koch, Christian; Sander, Michael

doi:10.1007/s10877-019-00433-6

Cited by 77 publications

(65 citation statements)

References 35 publications

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“…Schneck et al 25 compared in a randomized blinded prospective interventional trial a HPI group with a standard routine care group and a historical control group. They reported a significant reduction in intraoperative hypotension in the HPI group.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

Grundmann

Wischermann

Faßbender

et al. 2021

Acta Anaesthesiol Scand

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Background Intraoperative hypotension is associated with increased morbidity and mortality. The Hypotension Prediction Index (HPI) is an advancement of the arterial waveform analysis to predict intraoperative hypotension minutes before episodes occur enabling preventive treatments. We tested the hypothesis that the HPI combined with a personalized treatment protocol reduces intraoperative hypotension when compared to arterial waveform analysis alone. Methods We conducted a retrospective analysis of 100 adult consecutive patients undergoing moderate‐ or high‐risk noncardiac surgery with invasive arterial pressure monitoring using either index guidance (HPI) or arterial waveform analysis (FloTrac) depending on availability (FloTrac, n = 50; HPI, n = 50). A personalized treatment protocol was applied in both groups. The primary endpoint was the incidence and duration of hypotensive events defined as MAP <65 mmHg evaluated by time‐weighted average of hypotension. Results In the FloTrac group, 42 patients (84%) experienced a hypotension while in the HPI group 26 patients (52%) were hypotensive (p = 0.001). The median (IQR) time‐weighted average of hypotension in the FloTrac group was 0.27 (0.42) mmHg versus 0.10 (0.19) mmHg in the HPI group (p = 0.001). Finally, the median duration of each hypotensive event (IQR) was 2.75 (2.40) min in the FloTrac group compared to 1.00 (2.06) min in the HPI group (p = 0.002). Conclusions The application of the HPI combined with a personalized treatment protocol can reduce incidence and duration of hypotension when compared to arterial waveform analysis alone. This study therefore provides further evidence of the transition from prediction to actual prevention of hypotension using HPI.

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Section: Discussionmentioning

confidence: 99%

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

Grundmann

Wischermann

Faßbender

et al. 2021

Acta Anaesthesiol Scand

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“…Noticeably, a lower HPI threshold of 80 was used, according to the authors to enable early intervention. 31 Recently, our group conducted a similar pilot RCT in a heterogeneous surgical population. A total of 68 patients were assigned to an HPI-guided treatment protocol or to standard care.…”

Section: Clinical Validationmentioning

confidence: 99%

One of the first validations of an artificial intelligence algorithm for clinical use: The impact on intraoperative hypotension prediction and clinical decision-making

Ven

Veelo

Wijnberge

et al. 2021

Surgery

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“…Although a recent study by Maheshwari et al conducted in 214 patients undergoing non-cardiac surgery questioned the role of HPI [12], most of the published evidence supports the value of HPI in predicting hypotension. Indeed, such results have been found in patients undergoing total hip arthroplasty [13], major/general surgery [14,15] and cardiac surgery [16]. Such studies have demonstrated good sensibility and speci city in predicting hypotension from 5 minutes (both around 85%) to 15 minutes (both around 75%-80%) before the hypotensive episode [14,16,17].…”

Section: Discussionmentioning

confidence: 93%

Performance of Hypotension Prediction Index for Prevention of Hypotension and Results on Biomarkers of Organ Injury and Oxidative Stress During Elective Non-Cardiac Surgery: A Randomized Controlled Trial

Murabito

Astuto

Sanfilippo

et al. 2021

Preprint

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Background: Intraoperative hypotension is associated with increased postoperative morbidity and mortality. We tested whether the clinical application of an early warning system (EWS) in combination with an algorithm for hemodynamic management reduces the occurrence of intraoperative hypotension as well as decrease the degree of organ injury and oxidative stress. Methods: We randomly assigned patients undergoing major general surgery EWS and hemodynamic algorithm (intervention group, n=20) or standard care (n=20). The primary outcome was the difference in hypotension (defined as mean arterial pressure<65mmHg) evaluated as episodes, time and time-weighted average of hypotension. As secondary outcome we assessed surrogate markers of organ injury (neuron specific enolase -NSE), S100B protein, high-sensitive troponin, neutrophil gelatinase-associated lipocalin -NGAL) and oxidative stress (reduced glutathione). Results: The median number of hypotensive episodes was lower in the intervention group [-5.0 (95%CI:-9.0,-0.5);P<0.005], with lower time spent in hypotension [-12.8 minutes (95%CI:-38.0,-2.3 min);P<0.001], correspondent to -4.8% of total surgery time (95%CI: -12.7,0.01%; P<0.05). The median time-weighted average of hypotension was 0.12 mmHg (0.35) in the intervention group and 0.37 mmHg (1.11) in the control group, with a median difference of -0.25 mmHg (95%CI:-0.85, -0.01;P<0.05). NGAL was correlated with time-weighted average of hypotension (R=0.32;P<0.05) and S100B with all primary outcomes investigated (all P<0.001). The intervention group had lower NSE and higher reduced glutathione when compared to the control group. Conclusions: The use of an EWS coupled with an hemodynamic algorithm resulted in reduced intraoperative hypotension. This finding was coupled with a reduction of biomarkers of brain injury and oxidative stress.Trial Registration number and date: “Correlation Between Circulating Biomarkers of Organ Damage and Intraoperative Hypotension Management”, NCT03527758, registered on May 17, 2018.https://www.clinicaltrials.gov/ct2/show/NCT03527758?term=NCT03527758&draw=2&rank=1

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Hypotension Prediction Index based protocolized haemodynamic management reduces the incidence and duration of intraoperative hypotension in primary total hip arthroplasty: a single centre feasibility randomised blinded prospective interventional trial

Cited by 77 publications

References 35 publications

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

One of the first validations of an artificial intelligence algorithm for clinical use: The impact on intraoperative hypotension prediction and clinical decision-making

Performance of Hypotension Prediction Index for Prevention of Hypotension and Results on Biomarkers of Organ Injury and Oxidative Stress During Elective Non-Cardiac Surgery: A Randomized Controlled Trial

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