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. 2025 Feb 13;5(1):7.
doi: 10.1186/s44158-024-00222-x.

Intraoperative hemodynamic management in abdominal aortic surgery guided by the Hypotension Prediction Index: the Hemas multicentric observational study

Enrico Giustiniano  1 , Fulvio Nisi  2   3 , Federica Ferrod  4 , Giulia Lionetti  1 , Cristina Viscido  4 , Antonio Reda  1 , Federico Piccioni  1 , Gabriella Buono  4 , Maurizio Cecconi  5   6
Affiliations

Intraoperative hemodynamic management in abdominal aortic surgery guided by the Hypotension Prediction Index: the Hemas multicentric observational study

Enrico Giustiniano et al. J Anesth Analg Crit Care. .

Abstract

Background: Intraoperative hypotension (IOH) during non-cardiac surgery is closely associated with postoperative complications. Hypotensive events are more likely during major open vascular surgery. We prospectively investigated whether our institutional algorithm of cardiocirculatory management, which included the Hypotension Prediction Index (HPI), a predictive model of hypotension of the Hemosphere™ platform (Edwards Lifescience, Irwin, CA, USA), was able to reduce the incidence and severity of intraoperative hypotension during open abdominal aortic aneurysm repair.

Methods: A multi-center observational study was conducted at IRCCS-Humanitas Research Hospital (Milan) and AO Mauriziano Umberto I Hospital (Turin) between July 2022 and September 2023, enrolling patients undergoing elective open abdominal aortic aneurysm repair. A hemodynamic protocol based on the Acumen-HPI Hemosphere™ platform was employed, integrating advanced parameters (e.g., HPI, Ea-dyn, dP/dt) and tailored interventions to minimize intraoperative hypotension. The primary endpoint was cumulative intraoperative hypotension time < 10% of surgical time, with secondary endpoints including incidence of hypotensive events, time-weighted averages of MAP < 65 mmHg (TWA65) and < 50 mmHg (TWA50), and postoperative complications.

Results: We enrolled 53 patients submitted to open abdominal aortic repair. The primary endpoint (time in hypotension < 10%) was successfully reached: 5 [1-10] %. The targeted time-weighted average (< 0.40 mmHg) both for MAP < 65 mmHg (TWA65) and MAP < 50 mmHg (severe hypotension; TWA50) were reached: TWA65 = 0.26 [0.04-0.65] mmHg and TWA50 = 0.00 [0.00-0.01].

Conclusions: Our hemodynamic management algorithm based on the HPI and other parameters of the Hemosphere™ platform was able to limit the incidence and severity of intraoperative hypotension during open abdominal aortic repair.

Trial registration: NCT05478564.

Keywords: Abdominal aorta; Hemodynamic monitoring; Intraoperative hypo-tension; Open aortic repair; Vascular surgery.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The research protocol was reviewed and approved by the independent local Ethical Committee of the IRCCS Humanitas research hospital (Aut. n. 3236–19/07/2022) and was registered in ClinicalTrials.gov (NCT05478564). Informed consent was obtained from all subjects involved in the study. Confidentiality of participant information was maintained, and all data collected were anonymized to protect privacy. Consent for publication: All patient data were de-identified prior to being included in the study. Competing interests: F.P:, E.G., F.N. and M.C. have received funds from Edwards Lifesciences for teaching events. The other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Hemodynamic management protocol
Fig. 2
Fig. 2
Flow-chart of the study
Fig. 3
Fig. 3
Hemodynamic parameters time-points differences. *p < 0.05. CI cardiac index (L/min/m2), HR heart rate (bpm), Lactate serum concentration of lactic acid (mmol/L), dP/dt pressure variation within the time-unit (mmHg/s), MAP mean arterial pressure (mmHg), EtCO2 end-tidal carbon dioxide (mmHg) T1 basal, T2 5 min after aortic clamping, T3 5 min after aortic unclamping, T4 end of surgery After aortic clamping (from T1 to T2), blood pressure, heart rate and dP/dt reduced significantly, while only dP/dt changed in the following phases
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References

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