Key result
HPI-guided management reduces time-weighted MAP < 65 mmHg vs standard care in non-cardiac surgery.
Why the study?
The efficacy of the Hypotension Prediction Index for reducing intraoperative hypotension among patients undergoing non-cardiac surgeries remains unclear.
Does Hypotension Prediction Index (HPI)-guided therapy reduce intraoperative hypotension in adult patients undergoing non-cardiac surgeries?
Meta-Analysis (n=789)
Does Hypotension Prediction Index (HPI)-guided therapy reduce intraoperative hypotension in adult patients undergoing non-cardiac surgeries?
Mean Difference: -0.23 (95% CI -0.35–-0.1)
p-value: p=<0.01
HPI-guided therapy reduces the duration and severity of intraoperative hypotension in non-cardiac surgeries, though without significant differences in adverse events like AKI.
Supports HPI use to reduce intraoperative hypotension duration in non-cardiac surgery; confirms hemodynamic benefit while leaving clinical outcome impact open.
BACKGROUND: The efficacy of the Hypotension Prediction Index (HPI) for reducing Intraoperative Hypotension (IOH) among patients undergoing non-cardiac surgeries remains unclear. We aimed to perform a systematic review, meta-analysis, and trial sequential analysis to determine whether the HPI is effective for adult patients undergoing non-cardiac surgeries. This study was prospectively registered in the PROSPERO database (CRD42024571931). METHODS: PubMed, Embase, and Cochrane were systematically searched for Randomized Controlled Trials (RCTs) comparing HPI-guided therapy with standard care in non-cardiac surgeries. We computed Mean Difference (MD) and Risk Ratios (RR) for continuous and binary outcomes, respectively, with 95 % Confidence Intervals (95 % CI). Statistical analyses were performed using R Software, version 4.2.3. RESULTS: ; 95 % CI -143.4 to -50.98; p < 0.01). HPI also decreased the duration of MAP < 65 mmHg (MD = -16.22 min; 95 % CI -25.87 to -6.57; p < 0.01) and the number of hypotensive episodes per patient (MD = -3.38; 95 % CI -5.38 to -1.37; p < 0.01). No significant differences were observed in the number of hypotensive events, phenylephrine use, or AKI incidence (p > 0.05). CONCLUSION: In adult patients undergoing non-cardiac surgeries, HPI use was associated with a reduction in the duration and severity of IOH, with no significant difference for adverse events. Limitations include significant heterogeneity across studies, differences in HPI implementation, and lack of long-term outcome data.
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Felippe et al. (2025) conducted a meta-analysis in Intraoperative hypotension in non-cardiac surgeries (n=789). Hypotension Prediction Index (HPI) vs. Standard care was evaluated on Time-Weighted Average (TWA) of Mean Arterial Pressure (MAP) < 65 mmHg (MD -0.23, 95% CI -0.35 to -0.10, p=<0.01). Hypotension Prediction Index (HPI)-guided management significantly reduced the time-weighted average of mean arterial pressure < 65 mmHg (MD -0.23 mmHg.min-1) compared to standard care in non-cardiac surgeries.
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