Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension.
hemodynamics
hypotension
monitoring
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
revised:
16
07
2021
received:
09
06
2021
accepted:
19
07
2021
pubmed:
30
7
2021
medline:
9
11
2021
entrez:
29
7
2021
Statut:
ppublish
Résumé
Intraoperative hypotension is associated with increased morbidity and mortality. The Hypotension Prediction Index (HPI) is an advancement of the arterial waveform analysis to predict intraoperative hypotension minutes before episodes occur enabling preventive treatments. We tested the hypothesis that the HPI combined with a personalized treatment protocol reduces intraoperative hypotension when compared to arterial waveform analysis alone. We conducted a retrospective analysis of 100 adult consecutive patients undergoing moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring using either index guidance (HPI) or arterial waveform analysis (FloTrac) depending on availability (FloTrac, n = 50; HPI, n = 50). A personalized 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 time-weighted average of hypotension. In the FloTrac group, 42 patients (84%) experienced a hypotension while in the HPI group 26 patients (52%) were hypotensive (p = 0.001). The median (IQR) time-weighted average of hypotension in the FloTrac group was 0.27 (0.42) mmHg versus 0.10 (0.19) mmHg in the HPI group (p = 0.001). Finally, the median duration of each hypotensive event (IQR) was 2.75 (2.40) min in the FloTrac group compared to 1.00 (2.06) min in the HPI group (p = 0.002). The application of the HPI combined with a personalized treatment protocol can reduce incidence and duration of hypotension when compared to arterial waveform analysis alone. This study therefore provides further evidence of the transition from prediction to actual prevention of hypotension using HPI.
Sections du résumé
BACKGROUND
BACKGROUND
Intraoperative hypotension is associated with increased morbidity and mortality. The Hypotension Prediction Index (HPI) is an advancement of the arterial waveform analysis to predict intraoperative hypotension minutes before episodes occur enabling preventive treatments. We tested the hypothesis that the HPI combined with a personalized treatment protocol reduces intraoperative hypotension when compared to arterial waveform analysis alone.
METHODS
METHODS
We conducted a retrospective analysis of 100 adult consecutive patients undergoing moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring using either index guidance (HPI) or arterial waveform analysis (FloTrac) depending on availability (FloTrac, n = 50; HPI, n = 50). A personalized 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 time-weighted average of hypotension.
RESULTS
RESULTS
In the FloTrac group, 42 patients (84%) experienced a hypotension while in the HPI group 26 patients (52%) were hypotensive (p = 0.001). The median (IQR) time-weighted average of hypotension in the FloTrac group was 0.27 (0.42) mmHg versus 0.10 (0.19) mmHg in the HPI group (p = 0.001). Finally, the median duration of each hypotensive event (IQR) was 2.75 (2.40) min in the FloTrac group compared to 1.00 (2.06) min in the HPI group (p = 0.002).
CONCLUSIONS
CONCLUSIONS
The application of the HPI combined with a personalized treatment protocol can reduce incidence and duration of hypotension when compared to arterial waveform analysis alone. This study therefore provides further evidence of the transition from prediction to actual prevention of hypotension using HPI.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1404-1412Informations de copyright
© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
Références
Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KGM, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007;107:213-220.
Vernooij LM, van Klei WA, Machina M, Pasma W, Beattie WS, Peelen LM. Different methods of modelling intraoperative hypotension and their association with postoperative complications in patients undergoing non-cardiac surgery. Br J Anaesth. 2018;120:1080-1089.
An R, Pang Q-Y, Liu H-L. Association of intra-operative hypotension with acute kidney injury, myocardial injury and mortality in non-cardiac surgery: a meta-analysis. Int J Clin Pract. 2019;73:e13394.
Salmasi V, Maheshwari K, Yang D, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2017;126:47-65.
Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018;121:706-721.
Scholz AFM, Oldroyd C, McCarthy K, Quinn TJ, Hewitt J. Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery. Br J Surg. 2016;103:e21-e28.
Bijker JB, Persoon S, Peelen LM, et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology. 2012;116:658-664.
Ahuja S, Mascha EJ, Yang D, et al. Associations of intraoperative radial arterial systolic, diastolic, mean, and pulse pressures with myocardial and acute kidney injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2020;132:291-306.
Mascha EJ, Yang D, Weiss S, Sessler DI. Intraoperative mean arterial pressure variability and 30-day mortality in patients having noncardiac surgery. Anesthesiology. 2015;123:79-91.
Walsh M, Devereaux PJ, Garg AX, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507-515.
Mathis MR, Naik BI, Freundlich RE, et al. Preoperative risk and the association between hypotension and postoperative acute kidney injury. Anesthesiology. 2020;132:461-475.
Suehiro K, Tanaka K, Mikawa M, et al. Improved performance of the fourth-generation FloTrac/Vigileo system for tracking cardiac output changes. J Cardiothorac Vasc Anesth. 2015;29:656-662.
Kouz K, Scheeren TWL, de Backer D, Saugel B. Pulse wave analysis to estimate cardiac output. Anesthesiology. 2020; 134:119-126.
Futier E, Lefrant J-Y, Guinot P-G, et al. Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial. JAMA. 2017;318:1346-1357.
Hatib F, Jian Z, Buddi S, et al. Machine-learning algorithm to predict hypotension based on high-fidelity arterial pressure waveform analysis. Anesthesiology. 2018;129:663-674.
Davies SJ, Vistisen ST, Jian Z, Hatib F, Scheeren TWL. Ability of an arterial waveform analysis-derived hypotension prediction index to predict future hypotensive events in surgical patients. Anest Analg. 2020;130:352-359.
Maheshwari K, Khanna S, Bajracharya GR, et al. A randomized trial of continuous noninvasive blood pressure monitoring during noncardiac surgery. Anest Analg. 2018;127:424-431.
Funcke S, Saugel B, Koch C, et al. Individualized, perioperative, hemodynamic goal-directed therapy in major abdominal surgery (iPEGASUS trial): study protocol for a randomized controlled trial. Trials. 2018;19:273.
Colantonio L, Claroni C, Fabrizi L, et al. Randomized trial of goal directed vs standard fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. J Gastrointest Surg. 2015;19:722-729.
Asfar P, Meziani F, Hamel J-F, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370:1583-1593.
Maheshwari K, Shimada T, Fang J, et al. Hypotension Prediction Index software for management of hypotension during moderate- to high-risk noncardiac surgery: protocol for a randomized trial. Trials. 2019;20:255.
Edwards Lifesciences Corporation. Edwards HemoSphere advanced monitor operator’s manual. Accessed January 27, 2021. https://eifu.edwards.com/eifu/5970f1b346e0fb00015e5f4d/DOC-0133394A.pdf
Wijnberge M, Geerts BF, Hol L, et al. Effect of a machine learning-derived early warning system for intraoperative hypotension vs standard care on depth and duration of intraoperative hypotension during elective noncardiac surgery: the HYPE randomized clinical trial. JAMA. 2020;323:1052-1060.
Demetriou C, Hu L, Smith TO, Hing CB. Hawthorne effect on surgical studies. ANZ J Surg. 2019;89:1567-1576.
Schneck E, Schulte D, Habig L, et al. Hypotension Prediction Index based protocolized haemodynamic management reduces the incidence and duration of intraoperative hypotension in primary total hip arthroplasty: a single centre feasibility randomised blinded prospective interventional trial. J Clin Monit Comput. 2020;34:1149-1158.
Mukai A, Suehiro K, Watanabe R, et al. Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial. Br J Anaesth. 2020;125:953-961.
Kim J, Na S, Yoo YC, Koh SO. Implementing a sepsis resuscitation bundle improved clinical outcome: a before-and-after study. Korean J Crit Care Med. 2014;29:250.
Michard F, Giglio MT, Brienza N. Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome. Br J Anaesth. 2017;119:22-30.
Maheshwari K, Shimada T, Yang D, et al. Hypotension prediction index for prevention of hypotension during moderate- to high-risk noncardiac surgery. Anesthesiology. 2020.
McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67:267-277.
Green RS, Butler MB. Postintubation hypotension in general anesthesia: a retrospective analysis. J Intensive Care Med. 2016;31:667-675.
Maheshwari K, Turan A, Mao G, et al. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia. 2018;73:1223-1228.
Saugel B, Kouz K, Hoppe P, Maheshwari K, Scheeren TWL. Predicting hypotension in perioperative and intensive care medicine. Best Pract Res Clin Anaesthesiol. 2019;33:189-197.
Neuhauser H, Kuhnert R, Born S. 12-Monats-Prävalenz von Bluthochdruck in Deutschland. J Health Monitor. 2017;57-63.
Saugel B, Reuter DA, Reese PC. Intraoperative mean arterial pressure targets: can databases give us a universally valid "magic number" or does physiology still apply for the individual patient? Anesthesiology. 2017;127:725-726.
Edwards Lifesciences Corporation. FloTrac system. Accessed January 27, 2021. https://www.edwards.com/devices/hemodynamic-monitoring/FloTrac
Edwards Lifesciences Corporation. Acumen hypotension prediction index software. Accessed January 27, 2021. https://www.edwards.com/pages/acumen-hpi
Nakasuji M, Okutani A, Miyata T, et al. Disagreement between fourth generation FloTrac and LiDCOrapid measurements of cardiac output and stroke volume variation during laparoscopic colectomy. J Clin Anesth. 2016;35:150-156.
Power P, Bone A, Simpson N, Yap C-H, Gower S, Bailey M. Comparison of pulmonary artery catheter, echocardiography, and arterial waveform analysis monitoring in predicting the hemodynamic state during and after cardiac surgery. Int J Crit Illn Inj Sci. 2017;7:156-162.
Milam AJ, Ghoddoussi F, Lucaj J, et al. Comparing the mutual interchangeability of ECOM, FloTrac/Vigileo, 3D-TEE, and ITD-PAC cardiac output measuring systems in coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2020;35:514-529.