Effect of Hypotension Prediction Index-guided intraoperative haemodynamic care on depth and duration of postoperative hypotension: a sub-study of the Hypotension Prediction trial.

BACKGROUND

Intraoperative and postoperative hypotension are associated with morbidity and mortality. The Hypotension Prediction (HYPE) trial showed that the Hypotension Prediction Index (HPI) reduced the depth and duration of intraoperative hypotension (IOH), without excess use of intravenous fluid, vasopressor, and/or inotropic therapies. We hypothesised that intraoperative HPI-guided haemodynamic care would reduce the severity of postoperative hypotension in the PACU.

METHODS

This was a sub-study of the HYPE study, in which 60 adults undergoing elective noncardiac surgery were allocated randomly to intraoperative HPI-guided or standard haemodynamic care. Blood pressure was measured using a radial intra-arterial catheter, which was connected to a FloTracIQ sensor. Hypotension was defined as MAP <65 mm Hg, and a hypotensive event was defined as MAP <65 mm Hg for at least 1 min. The primary outcome was the time-weighted average (TWA) of postoperative hypotension. Secondary outcomes were absolute incidence, area under threshold for hypotension, and percentage of time spent with MAP <65 mm Hg.

RESULTS

Overall, 54/60 (90%) subjects (age 64 (8) yr; 44% female) completed the protocol, owing to failure of the FloTracIQ device in 6/60 (10%) patients. Intraoperative HPI-guided care was used in 28 subjects; 26 subjects were randomised to the control group. Postoperative hypotension occurred in 37/54 (68%) subjects. HPI-guided care did not reduce the median duration (TWA) of postoperative hypotension (adjusted median difference, vs standard of care: 0.118; 95% confidence interval [CI], 0-0.332; P=0.112). HPI-guidance reduced the percentage of time with MAP <65 mm Hg by 4.9% (adjusted median difference: -4.9; 95% CI, -11.7 to -0.01; P=0.046).

CONCLUSIONS

Intraoperative HPI-guided haemodynamic care did not reduce the TWA of postoperative hypotension.

Informations de copyright

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declarations of interest The Department of Anaesthesiology of the Amsterdam UMC, location ‘AMC' received financial support for this project from Edwards Lifesciences. DPV, APV, MW, RVI, and BFG received consultancy fees from Edwards Lifesciences. The Hypotension Prediction Index algorithm is proprietary to Edwards Lifesciences LLC. None of the investigators of the Amsterdam UMC have any form of (in)direct ownership in the algorithm, software or hardware of Edwards, and/or subject of this study. Also, no rights or claims to rights exist that might lead to financial gains for any of the authors or the Amsterdam UMC as an institution. BFG and DPV received consultancy fees and research grants from Philips outside the submitted word. MWH is executive section editor Pharmacology with Anesthesia & Analgesia. He received consultancy fees from Eurocept BV and speakers fees from Eurocept and CSL Behring. JS, JMM, BJPS, and LH declare that they have no conflict of interest.