Perioperative goal-directed therapy with artificial intelligence to reduce the incidence of intraoperative hypotension and renal failure in patients undergoing lung surgery: A pilot study

STUDY OBJECTIVE: The aim of this study was to investigate whether goal-directed treatment using artificial intelligence, compared to standard care, can reduce the frequency, duration, and severity of intraoperative hypotension in patients undergoing single lung ventilation, with a potential reduction of postoperative acute kidney injury (AKI). DESIGN: single center, single-blinded randomized controlled trial. SETTING: University hospital operating room. PATIENTS: 150 patients undergoing lung surgery with single lung ventilation were included. INTERVENTIONS: Patients were randomly assigned to two groups: the Intervention group, where a goal-directed therapy based on the Hypotension Prediction Index (HPI) was implemented; the Control group, without a specific hemodynamic protocol. MEASUREMENTS: The primary outcome measures include the frequency, duration of intraoperative hypotension, furthermore the Area under MAP 65 and the time-weighted average (TWA) of MAP of 65. Other outcome parameters are the incidence of AKI and myocardial injury after non-cardiac surgery (MINS). MAIN RESULTS: The number of hypotensive episodes was lower in the intervention group compared to the control group (0 0-1 vs. 1 0-2; p = 0.01), the duration of hypotension was shorter in the intervention group (0 min 0-3.17 vs. 2.33 min 0-7.42; p = 0.01). The area under the MAP of 65 (0 mmHg * min 0-12 vs. 10.67 mmHg * min 0-44.16; p < 0.01) and the TWA of MAP of 65 (0 mmHg 0-0.08 vs. 0.07 mmHg 0-0.25; p < 0.01) were lower in the intervention group. The incidence of postoperative AKI showed no differences between the groups (6.7 % vs.4.2 %; p = 0.72). There was a trend to lower incidence of MINS in the intervention group (17.1 % vs. 31.8 %; p = 0.07). A tendency towards reduced postoperative infection was seen in the intervention group (16.0 % vs. 26.8 %; p = 0.16). CONCLUSIONS: The implementation of a treatment algorithm based on HPI allowed us to decrease the duration and severity of hypotension in patients undergoing lung surgery. It did not result in a significant reduction in the incidence of AKI, however we observed a tendency towards lower incidence of MINS in the intervention group, along with a slight reduction in postoperative infections.