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December 19, 2023Journal of Clinical Monitoring and ComputingOpen Access

Impact of clinicians’ behavior, an educational intervention with mandated blood pressure and the hypotension prediction index software on intraoperative hypotension: a mixed methods study

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Why the study?

Intraoperative hypotension is associated with adverse outcomes, prompting an exploration of clinicians' beliefs and treatment barriers, alongside evaluating whether educational interventions with mandated blood pressure targets or Hypotension Prediction Index software reduce hypotension.

Does an educational intervention with mandated MAP targets or the use of Hypotension Prediction Index (HPI) software reduce intraoperative hypotension in elective major surgical patients?

Population

150 elective major surgical patients requiring invasive blood pressure monitoring and clinicians

Comparison

Standard care vs clinician training with mandated MAP > 65 mmHg vs HPI-protocolized care

Design

Mixed methods study

Authors

IKIlonka N. de KeijzerUniversity Medical Center GroningenJVJaap Jan VosUniversity Medical Center GroningenDYDavid YatesNorth Yorkshire County Council

Discussion

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Implication

HPI use was associated with less IOH while education plus mandated MAP was not; leaves open whether prospective trials will confirm benefit.

Structured PICO

Does an educational intervention with mandated MAP targets or the use of Hypotension Prediction Index (HPI) software reduce intraoperative hypotension in elective major surgical patients?

P
Population
150 elective major surgical patients who required invasive blood pressure monitoring, and clinicians (n=27 structured interviews, n=84 questionnaires, n=14 HPI questionnaires)
I
Intervention
Educational intervention with a mandated mean arterial pressure (MAP) > 65 mmHg (Cohort 2), or protocolized care using the Hypotension Prediction Index (HPI) software (Cohort 3)
C
Comparator
Standard care (baseline, Cohort 1)
O
Outcome
Incidence and time-weighted average (TWA) of intraoperative hypotension (MAP < 65 mmHg)surrogate

Protocolized care using the Hypotension Prediction Index (HPI) software significantly reduced the time-weighted average of intraoperative hypotension compared to standard care or an educational intervention alone.

Limitations

  • Conducted amidst the pandemic, which could have negatively impacted response rates and caused logistical challenges
  • Sequential study design where time and training could have influenced results
  • Design might have induced a selection bias
  • Difference in baseline TWA of hypotension between both centers

Cite This Study

Keijzer et al. (2023) studied this question.

synapsesocial.com/papers/6a7e45d2196d67da7483e2c8https://doi.org/10.1007/s10877-023-01097-z
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension2021 · 59 citations
  2. 2Prediction of intraoperative hypotension from the linear extrapolation of mean arterial pressure2022 · 44 citations
  3. 3Cardiovascular Function in Nonclinical Drug Safety Assessment2011 · 75 citations
  4. 4Common clinical thresholds of intraoperative hypotension and 30‐day mortality following surgery: A retrospective cohort study2020 · 12 citations
  5. 5Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery2016 · 1,140 citations