The “Hypotension Prediction Index (HPI)” represents a newly introduced monitoring-tool that aims to predict episodes of intraoperative hypotension (IOH) before their occurrence. In order to evaluate the feasibility of protocolized care according to HPI monitoring, we hypothesized that HPI predicts the incidence of IOH and reduces the incidence and duration of IOH. This single centre feasibility randomised blinded prospective interventional trial included at total of 99 patients. One group was managed by goal-directed therapy algorithm based on HPI (HPI, n = 25), which was compared to a routine anaesthetic care cohort (CTRL, n = 24) and a third historic control group (hCTRL, n = 50). Primary endpoints included frequency (n)/h, absolute and relative duration (t (min)/% of total anaesthesia time) of IOH. Significant reduction of intraoperative hypotension was recorded in the HPI group compared to the control groups (HPI 48%, CTRL 87.5%, hCTRL 80%; HPI vs. CTRL, respectively hCTRL p < 0.001). Perioperative quantity of IOH was significantly reduced in the interventional group compared to both other study groups (HPI: 0 (0–1), CTRL: 5 (2–6), hCTRL: 2 (1–3); p < 0.001). Same observations were identified for absolute (HPI: 0 (0–140) s, CTRL: 640 (195–1315) s, hCTRL 660 (180–1440) s; p < 0.001) and relative duration of hypotensive episodes (minutes MAP ≤ 65 mmHg in % of total anaesthesia time; HPI: 0 (0–1), CTRL: 6 (2–12), hCTRL 7 (2–17); p < 0.001). The HPI algorithm combined with a protocolized treatment was able to reduce the incidence and duration of hypotensive events in patients undergoing primary hip arthroplasty.
Trial registration: NCT03663270.
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This study was funded by an unrestricted research grant of Edward Lifesciences (Irvine, USA). Edwards Lifesciences was not involved in the design of this study, data generation or analysis nor writing of the manuscript.
Conflict of interest
M. Sander is a consultant for Edwards Lifesciences and Medtronic. E. Schneck and M. Habicher are consultants for Edwards Lifesciences. All other authors declare that they have no conflict of interest.
The trial was designed according to the guidelines of consolidated standards of reporting trials (CONSORT), approved by the local ethics committee (University of Giessen, No. 09/17) and registered at ClincalTrials.gov (Registration No. NCT03663270).
Research involving human participants and/or animals
This article does not contain any studies with animals performed by any of the authors.
All prospective patients gave informed consent and retrospective data were anonymized.
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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 34, 1149–1158 (2020). https://doi.org/10.1007/s10877-019-00433-6
- Intraoperative hypotension
- Goal-directed therapy
- Hypotension Prediction Index
- Total hip arthroplasty