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Comparative Study
. 2025 Oct;72(8):501803.
doi: 10.1016/j.redare.2025.501803. Epub 2025 May 23.

The effect of structured proctoring and hypotension prediction index teaching on incidence and duration of intraoperative hypotension in patients undergoing major abdominal surgery: A comparative study of two monitoring systems

J Ripollés-Melchor  1 , P Fernández-Valdés-Bango  2 , D García-López  3 , M Olvera-García  4 , J L Tomé-Roca  5 , C A Vargas-Berenjeno  6 , A Ruiz-Escobar  2 , A B Adell-Pérez  7 , L Carrasco-Sánchez  8 , A Abad-Gurumeta  9 , J V Lorente  10 , A V Espinosa  11 , I Jiménez-López  12 , M A Valbuena-Bueno  13 , M I Monge-García  14
Affiliations
Comparative Study

The effect of structured proctoring and hypotension prediction index teaching on incidence and duration of intraoperative hypotension in patients undergoing major abdominal surgery: A comparative study of two monitoring systems

J Ripollés-Melchor et al. Rev Esp Anestesiol Reanim (Engl Ed). 2025 Oct.

Abstract

Introduction: Intraoperative hypotension (IOH) is a commonly observed phenomenon during major abdominal surgery. The severity and duration of IOH have been identified as crucial factors in the development of these complications.

Methods: The study compares two groups of adult patients undergoing major abdominal surgery: one group received standard hemodynamic management using the Edwards Flotrac device, while the second group received hypotension prediction index duration, and severity of intraoperative hypotension in high-risk patients (HPI)-guided hemodynamic management, with anesthesiologists trained via a structured proctoring program. We retrospective analized prospectively gathered anonymized data from 6 Spanish centers during 2021-2022. The primary outcome measure was the time-weighted average of mean arterial pressure < 65 mmHg (MAP) during surgery (TWA MAP 65 mmHg). The secondary outcome measures included incidence of hypotensive episodes, total time with hypotension, and percentage of time spent in hypotension during surgery.

Results: A total of 607 patients were analyzed, 270 in the pre-proctoring group vs 337 in the post-proctoring group. The median TWA MAP 65 mmHg was 0.09 mm Hg (interquartile range (IQR), 0.00-0.31 mm Hg) post-proctoring group vs 0.37 mmHg (IQR, 0.08-1.01 mm Hg) in the pre-proctoring group, for a median difference of 0.19 mmHg (95% CI, 0.13-0.27 mmHg; P < .001), whereas the median TWA MAP < 55 mmHg was 0.00 mmHg (IQR, 0.00-0.01 mmHg) post-proctoring group vs 0.00 mmHg (IQR, 0.00-0.07 mm Hg) in the pre-proctoring group, 0 mmHg (95% CI, 0.0-0.02 mm Hg; P < .001).

Conclusions: A structured program in hemodynamic training based on the intraoperative use of the hemodynamic prediction index decreases the incidence.

Keywords: Critical care; Cuidados críticos; Decision making; Fisiología; Hemodinámica; Hemodynamics; Physiology; Toma de decisiones.

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Conflict of interest statement

Declaration of competing interest JRM: has received honoraria for conferences and served on Edwards Lifesciences. Advisory boards. LCS: has received honoraria for conferences from Edwards Lifesciences. JTR: has received honoraria for conferences from Edwards Lifesciences JVL: has received honoraria for conferences and served on Edwards Lifesciences. Advisory boards. IJL: has received honoraria for conferences and served on Edwards Lifesciences. Advisory boards. MIMG: has been an employee of Edwards Lifesciences and is currently clinical consultant for Edwards Lifesciences. The other authors declare that this review was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Edwards Lifesciences was not involved in the design, conduct of the review, collection, management, analysis, or interpretation of the data, preparation, and review of the manuscript, or in the decision to publish.

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