The Use of the Hypotension Prediction Index Integrated in an Algorithm of Goal Directed Hemodynamic Treatment during Moderate and High-Risk Surgery

Marina Tsoumpa; Aikaterini Kyttari; Stamo Matiatou; Maria Tzoufi; Panayota Griva; Emmanouil Pikoulis; Maria Riga; Paraskevi Matsota; Tatiana Sidiropoulou

doi:10.3390/jcm10245884

The Use of the Hypotension Prediction Index Integrated in an Algorithm of Goal Directed Hemodynamic Treatment during Moderate and High-Risk Surgery

J Clin Med. 2021 Dec 15;10(24):5884. doi: 10.3390/jcm10245884.

Authors

Marina Tsoumpa¹, Aikaterini Kyttari¹, Stamo Matiatou¹, Maria Tzoufi¹, Panayota Griva¹, Emmanouil Pikoulis², Maria Riga¹, Paraskevi Matsota¹, Tatiana Sidiropoulou¹

Affiliations

¹ Second Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece.
² Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece.

Abstract

(1) Background: The Hypotension Prediction Index (HPI) is an algorithm that predicts hypotension, defined as mean arterial pressure (MAP) less than 65 mmHg for at least 1 min, based on arterial waveform features. We tested the hypothesis that the use of this index reduces the duration and severity of hypotension during noncardiac surgery. (2) Methods: We enrolled adults having moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring. Participating patients were randomized 1:1 to standard of care or hemodynamic management with HPI guidance with a goal directed hemodynamic treatment protocol. The trigger to initiate treatment (with fluids, vasopressors, or inotropes) was a value of HPI of 85 (range, 0-100) or higher in the intervention group. Primary outcome was the amount of hypotension, defined as time-weighted average (TWA) MAP less than 65 mmHg. Secondary outcomes were time spent in hypertension defined as MAP more than 100 mmHg for at least 1 min; medication and fluids administered and postoperative complications. (3) Results: We obtained data from 99 patients. The median (IQR) TWA of hypotension was 0.16 mmHg (IQR, 0.01-0.32 mmHg) in the intervention group versus 0.50 mmHg (IQR, 0.11-0.97 mmHg) in the control group, for a median difference of -0.28 (95% CI, -0.48 to -0.09 mmHg; p = 0.0003). We also observed an increase in hypertension in the intervention group as well as a higher weight-adjusted administration of phenylephrine in the intervention group. (4) Conclusions: In this single-center prospective study of patients undergoing elective noncardiac surgery, the use of this prediction model resulted in less intraoperative hypotension compared with standard care. An increase in the time spent in hypertension in the treatment group was also observed, probably as a result of overtreatment. This should provide an insight for refining the use of this prediction index in future studies to avoid excessive correction of blood pressure.

Keywords: Hypotension Prediction Index; goal directed hemodynamic therapy; intraoperative hypotension; machine learning; non-cardiac surgery.