Hypotension prediction index: From reactive to predictive hemodynamic management, the key to maintaining hemodynamic stability

Background The Hypotension Prediction Index (the index) software is a machine learning algorithm that detects physiological changes that may lead to hypotension. The original validation used a case control (backwards) analysis that has been suggested to be biased. We therefore conducted a cohort (forwards) analysis and compared this to the original validation technique. Methods We conducted a retrospective analysis of data from previously reported studies. All data were analysed identically with 2 different methodologies and receiver operating characteristic curves (ROC) constructed. Both backwards and forwards analyses were performed to examine differences in area under the ROC for HPI and other haemodynamic variables to predict a MAP < 65mmHg for at least 1 minute 5, 10 and 15 minutes in advance. Results Two thousand and twenty-two patients were included in the analysis, yielding 4,152,124 measurements taken at 20 second intervals. The area-under-the-curve for the index predicting hypotension analysed by backward and forward methodologies respectively was 0.957 (95% CI, 0.947–0.964) vs 0.923 (95% CI, 0.912–0.933) 5 minutes in advance, 0.933 (95% CI, 0.924–0.942) vs 0.923 (95% CI, 0.911–0.933) 10 minutes in advance , and 0.929 (95% CI, 0.918–0.938) vs. 0.926 (95% CI, 0.914–0.937) 15 minutes in advance. No other variable had an area-under-the-curve > 0.7 except for MAP. Area-under-the-curve using forward analysis for MAP predicting hypotension 5, 10, and 15 minutes in advance was 0.932 (95% CI, 0.920–0.940), 0.929 (95% CI, 0.918–0.938), and 0.932 (95% CI, 0.921–0.940). The R 2 for the variation in the index due to MAP was 0.77. Conclusion Using an updated methodology, we found the utility of the HPI index to predict future hypotensive events is high, with an area under the receiver-operating-characteristics curve similar to that of the original validation method.

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Hypotension prediction index guided goal-directed therapy to reduce postoperative acute kidney injury during major abdominal surgery: study protocol for a multicenter randomized controlled clinical trial

Ripollés-Melchor,

Carrasco-Sánchez,

Tomé-Roca

et al. 2024

Trials

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Background Acute kidney injury (AKI) is a significant postoperative complication associated with increased mortality and hospital costs. Hemodynamic strategies, such as goal-directed therapy, might reduce AKI risk. Predicting and proactively managing intraoperative hypotension may be helpful. This trial aims to investigate if a preemptive hemodynamic strategy guided by the hypotension prediction index (HPI) can decrease the incidence of moderate-to-severe AKI within 30 days following major elective abdominal surgery. Methods This is an open-label, controlled, multicenter, randomized clinical trial that involves daily patient follow-up until hospital discharge. Inclusion criteria are patients aged over 65 and/or categorized as ASA III or IV physical status, undergoing major elective abdominal surgery (general, urological, or gynecological procedures) via laparoscopic or open approach under general or combined anesthesia. Intervention In the intervention group, hemodynamic management will be based on the HPI and the advanced functional hemodynamic variables provided by the Hemosphere platform and the AcumenIQ® sensor (Edwards Lifesciences). The primary outcome is the incidence of moderate-to-severe AKI within 7 days post-surgery. Secondary outcomes include postoperative complications and 30-day mortality. Discussion This study explores the potential of HPI-guided hemodynamic management in reducing AKI after major elective abdominal surgery, with implications for postoperative outcomes and patient care. Trial registration ClinicalTrials.gov NCT05569265. Registered on October 6, 2022.

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Hypotension prediction index: From reactive to predictive hemodynamic management, the key to maintaining hemodynamic stability

Cited by 4 publications

References 161 publications

Terapia hemodinámica guiada por objetivos mediante la administración de líquidos para optimizar el volumen sistólico: metaanálisis de ensayos controlados aleatorizados

Terapia hemodinámica guiada por objetivos mediante la administración de líquidos para optimizar el volumen sistólico: metaanálisis de ensayos controlados aleatorizados

Comparison of Differences in Cohort (Forward) and Case Control (Backward) Methodological Approaches for Validation of the Hypotension Prediction Index

Hypotension prediction index guided goal-directed therapy to reduce postoperative acute kidney injury during major abdominal surgery: study protocol for a multicenter randomized controlled clinical trial

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