Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT)

Karim Kouz¹, Manuel Ignacio Monge García², Elisabetta Cerutti³, Ivana Lisanti³, Gaetano Draisci⁴, Luciano Frassanito⁴, Michael Sander⁵, Amir Ali Akbari⁵, Ulrich H Frey⁶, Carla Davina Grundmann⁶, Simon James Davies^{7

8}, Abele Donati⁹, Javier Ripolles-Melchor¹⁰, Daniel García-López¹¹, Benjamin Vojnar¹², Étienne Gayat^{13

14}, Eric Noll¹⁵, Peter Bramlage¹⁶, Bernd Saugel^{1

17}

Affiliations

¹ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Unidad de Cuidados Intensivos, Hospital Universitario SAS Jerez, Jerez de La Frontera, Spain.
³ Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.
⁴ Department of Emergency, Intensive Care Medicine and Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
⁵ Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany.
⁶ Department of Anesthesiology, Intensive Care, Pain and Palliative Care, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany.
⁷ York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
⁸ Centre for Health and Population Sciences, Hull York Medical School, York, UK.
⁹ Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy.
¹⁰ Anesthesia and Critical Care Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
¹¹ Department of Anaesthesiology and Reanimation, University Hospital Marqués de Valdecilla, Santander, Spain.
¹² Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany.
¹³ Université Paris Cité, INSERM, Paris, France.
¹⁴ Department of Anesthesia and Critical Care Medicine, Hôpital Lariboisière, Paris, France.
¹⁵ Department of Anesthesiology and Intensive Care, Hôpital de Hautepierre, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
¹⁶ Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
¹⁷ Outcomes Research Consortium, Cleveland, OH, USA.

PMID: 37588176
PMCID: PMC10430826
DOI: 10.1016/j.bjao.2023.100140

Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT)

Karim Kouz et al. BJA Open. 2023.

. 2023 May 4:6:100140.

doi: 10.1016/j.bjao.2023.100140. eCollection 2023 Jun.

Authors

Affiliations

¹ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Unidad de Cuidados Intensivos, Hospital Universitario SAS Jerez, Jerez de La Frontera, Spain.
³ Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.
⁴ Department of Emergency, Intensive Care Medicine and Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
⁵ Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany.
⁶ Department of Anesthesiology, Intensive Care, Pain and Palliative Care, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany.
⁷ York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
⁸ Centre for Health and Population Sciences, Hull York Medical School, York, UK.
⁹ Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy.
¹⁰ Anesthesia and Critical Care Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
¹¹ Department of Anaesthesiology and Reanimation, University Hospital Marqués de Valdecilla, Santander, Spain.
¹² Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany.
¹³ Université Paris Cité, INSERM, Paris, France.
¹⁴ Department of Anesthesia and Critical Care Medicine, Hôpital Lariboisière, Paris, France.
¹⁵ Department of Anesthesiology and Intensive Care, Hôpital de Hautepierre, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
¹⁶ Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
¹⁷ Outcomes Research Consortium, Cleveland, OH, USA.

PMID: 37588176
PMCID: PMC10430826
DOI: 10.1016/j.bjao.2023.100140

Abstract

Background: Intraoperative hypotension is associated with organ injury. Current intraoperative arterial pressure management is mainly reactive. Predictive haemodynamic monitoring may help clinicians reduce intraoperative hypotension. The Acumen™ Hypotension Prediction Index software (HPI-software) (Edwards Lifesciences, Irvine, CA, USA) was developed to predict hypotension. We built up the European multicentre, prospective, observational EU HYPROTECT Registry to describe the incidence, duration, and severity of intraoperative hypotension when using HPI-software monitoring in patients having noncardiac surgery.

Methods: We enrolled 749 patients having elective major noncardiac surgery in 12 medical centres in five European countries. Patients were monitored using the HPI-software. We quantified hypotension using the time-weighted average MAP <65 mm Hg (primary endpoint), the proportion of patients with at least one ≥1 min episode of a MAP <65 mm Hg, the number of ≥1 min episodes of a MAP <65 mm Hg, and duration patients spent below a MAP of 65 mm Hg.

Results: We included 702 patients in the final analysis. The median time-weighted average MAP <65 mm Hg was 0.03 (0.00-0.20) mm Hg. In addition, 285 patients (41%) had no ≥1 min episode of a MAP <65 mm Hg; 417 patients (59%) had at least one. The median number of ≥1 min episodes of a MAP <65 mm Hg was 1 (0-3). Patients spent a median of 2 (0-9) min below a MAP of 65 mm Hg.

Conclusions: The median time-weighted average MAP <65 mm Hg was very low in patients in this registry. This suggests that using HPI-software monitoring may help reduce the duration and severity of intraoperative hypotension in patients having noncardiac surgery.

Keywords: artificial intelligence; blood pressure; haemodynamic instability; haemodynamic monitoring; machine learning; postoperative complications.

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Conflict of interest statement

KK, LF, MS, UHF, CDG, JR-M, and DG-L are consultants for and have received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). KK is a consultant for Vygon (Aachen, Germany). MIMG has been an employee of Edwards Lifesciences at the onset of the registry. EC has received honoraria for giving lectures from Edwards Lifesciences and MSD (Puteaux, France). MS has received research funding for investigator-initiated trials from Edwards Lifesciences, is a consultant for and has received honoraria for giving lectures from AMOMED (Vienna, Austria), and has received honoraria for giving lectures from Orion Pharma (Hamburg, Germany). AAA and BV have received honoraria for giving lectures from Edwards Lifesciences. UHF has received honoraria for giving lectures from CSL Behring (King of Prussia, PA, USA. SJD is a consultant for and has received honoraria for giving lectures and restricted and unrestricted research grants from Edwards Lifesciences. BV is a consultant for Ratiopharm GmbH (Ulm, Germany). EG is a consultant for Edwards Lifesciences and has received consultant fees from Baxter (Deerfield, IL, USA) and research grants from Radiometer (Krefeld, Germany) and Philips (Böblingen, Germany). EN is a consultant for and received honoraria from Edwards Lifesciences, Masimo (Neuchatel, Switzerland), and MSD. PB is a consultant for Edwards Lifesciences, and his institution IPPMed received research funding for the organisation of this project. BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Edwards Lifesciences, Baxter, GE Healthcare (Chicago, IL, USA), and Pulsion Medical Systems SE (Feldkirchen, Germany); is a consultant for and has received honoraria for giving lectures from Philips Medizin Systeme Böblingen GmbH (Böblingen, Germany); has received institutional restricted research grants and honoraria for giving lectures from CNSystems Medizintechnik GmbH (Graz, Austria); is a consultant for Maquet Critical Care (Solna, Sweden); has received honoraria for giving lectures from Getinge (Gothenburg, Sweden); is a consultant for and has received honoraria for giving lectures from Vygon; is a consultant for and has received institutional restricted research grants from Retia Medical LLC (Valhalla, NY, USA); has received institutional restricted research grants from Osypka Medical (Berlin, Germany); and was a consultant for and has received institutional restricted research grants from Tensys Medical, Inc. (San Diego, CA, USA). IL, GD, and AD declared to have no potential conflicts of interest.

Figures

**Fig 1**
Bar chart illustrating the time-weighted average MAP (TWA MAP) <65 mm Hg in patients of this registry and of previously published studies on Hypotension Prediction Index software (HPI-software) monitoring.^,, , .

See this image and copyright information in PMC

References

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Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT)

Affiliations

Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Medical