Why the study?
Intraoperative hypotension is common and associated with increased morbidity and mortality, but whether the Hypotension Prediction Index reduces hypotensive events in non-cardiac surgery patients remained to be tested.
Does the Hypotension Prediction Index reduce the incidence and duration of intraoperative hypotension in non-cardiac surgery patients?
Does the Hypotension Prediction Index reduce the incidence and duration of intraoperative hypotension in non-cardiac surgery patients?
The use of the Hypotension Prediction Index during non-cardiac surgery significantly reduces the time-weighted average of intraoperative hypotension, particularly in higher-risk patients.
Answers are grounded in this paper and cite their sources.
HPI use was associated with less hypotension; hypothesis-generating and requires RCTs before practice change.
(1) Background: Intraoperative hypotension is common and is associated with increased morbidity and mortality. The Hypotension Prediction Index (HPI) is an advancement of arterial waveform analysis and allows preventive treatments. We used a propensity-score-matched study design to test whether application of the HPI reduces hypotensive events in non-cardiac surgery patients; (2) Methods: 769 patients were selected for propensity score matching. After matching, both HPI and non-HPI groups together comprised n = 136 patients. A goal-directed 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 the time-weighted average (TWA) of hypotension. (3) Results: The median TWA of hypotension below 65 mmHg in the matched cohort was 0.180 mmHg (IQR 0.060, 0.410) in the non-HPI group vs. 0.070 mmHg (IQR 0.020, 0.240) in the HPI group (p < 0.001). TWA was higher in patients with ASA classification III/IV (0.170 mmHg; IQR 0.035, 0.365) than in patients with ASA status II (0.100; IQR 0.020, 0.250; p = 0.02). Stratification by intervention group showed no differences in the HPI group while TWA values in the non-HPI group were more than twice as high in patients with ASA status III/IV (p = 0.01); (4) Conclusions: HPI reduces intraoperative hypotension in a matched cohort seen for TWA below 65 mmHg and relative time in hypotension. In addition, non-HPI patients with ASA status III/IV showed a higher TWA compared with HPI-patients, indicating an advantageous effect of using HPI in patients at higher risk.
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Runge et al. (2023) studied this question.
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