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. 2025 Sep 5;14(17):6285.
doi: 10.3390/jcm14176285.

Comparison of Hemodynamic Management by Hypotension Prediction Index or Goal-Directed Therapy in Radical Cystectomies: A Prospective Observational Study

Claudia Brusasco  1 , Marco Micali  1 , Giada Cucciolini  2   3 , Desjan Filolli  2 , Michela Gandini  1 , Marco Lattuada  1 , Carlo Introini  4 , Francesco Corradi  2
Affiliations

Comparison of Hemodynamic Management by Hypotension Prediction Index or Goal-Directed Therapy in Radical Cystectomies: A Prospective Observational Study

Claudia Brusasco et al. J Clin Med. .

Abstract

Background: Hypotensive events may occur during surgical interventions and are associated with major postoperative complications, depending on their duration and severity. Intraoperative hemodynamic goal-directed therapy can reduce postoperative complications and mortality in high-risk surgeries and high-risk patients. The study hypothesis was that a proactive approach by hypotension predictive index (HPI) is more effective than a reactive goal-directed therapy (GDT) in reducing the number of hypotensive events during radical cystectomy and that this is associated with improved postoperative outcomes. Methods: The study was a single-center prospective observational study conducted at Galliera Hospital, from November 2019 to February 2025, with a before-after population of sixty-seven patients with reactive approach (GDT group) and sixty-five patients with a proactive approach (HPI group) undergoing radical cystectomy, managed with a standardized ERAS protocol and invasive or non-invasive hemodynamic monitoring. The aim of the study was to compare the incidence, duration, and severity of intraoperative hypotensive episodes between a proactive approach guided by the Hypotension Prediction Index (HPI) and a reactive goal-directed therapy (GDT) strategy guided by an advanced hemodynamic monitoring system. Results: The HPI group had a 65% reduction in hypotensive events (225 vs. 633, p < 0.001), with a 72% reduction in their duration (14 vs. 49 min, p < 0.001) and an 85% reduction in their severity (time-weighted average MAP < 65 mmHg 0.11 vs. 0.76, p < 0.001) compared to the GDT group. The HPI-guided group showed a reduction in postoperative infectious complications (10 vs. 26) and in-hospital length of stay (8 ± 4 versus 13 ± 8 days). Conclusions: A proactive approach may allow attenuating the occurrence and severity of hypotensive events more than a reactive goal-directed approach during radical cystectomy.

Keywords: ERAS protocol; Hypotension Prediction Index; goal-directed therapy; intraoperative hypotension; invasive and non-invasive hemodynamic monitoring; postoperative complications; radical cystectomy.

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Conflict of interest statement

All the authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Participant flow diagram.
Figure 2
Figure 2
Hemodynamic reactive approach applied to patients monitored through FloTrack or Clearsight sensors (GDT group).
Figure 3
Figure 3
Hemodynamic proactive approach to patients monitored through AcumenIQ or Acumen cuff sensors (HPI group).
Figure 4
Figure 4
Frequency, duration, and severity of hypotensive events in the reactive GDT group and in the proactive HPI group.
Figure 5
Figure 5
Distribution of duration of hypotensive events for MAP < 65 mmHg and MAP < 50 mmHg in the reactive GDT group and in the proactive HPI group.
Figure 6
Figure 6
Comparison of frequency, duration, and severity of hypotensive events in the reactive GDT group and in the proactive HPI group divided per non-invasive or invasive monitoring tool.
See this image and copyright information in PMC

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