Hypotension prediction index smart alerts and trends to improve compliance with goal-directed hemodynamic therapy: a feasibility study.
Background: Goal-directed hemodynamic therapy (GDHT) and Hypotension Prediction Index (HPI, Edwards Lifesciences, Irvine, CA) technology are used to improve post-operative patient outcomes. Trials evaluating GDHT are frequently limited by poor algorithm compliance. The Acumen HPI Software incorporat...
| Publicado en: | BMC Anesthesiology Vol. 25; no. 1; pp. 1 - 10 |
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| Autores principales: | , , , , , , , , , |
| Formato: | algorithm pictorial research tables/charts Journal Article |
| Publicado: |
BioMed Central
9/30/2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=188354564&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 188354564 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712253 1CH3 jtl: BMC Anesthesiology issn: 14712253 maglogo: N pubinfo: dt: 9/30/2025 vid: 25 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 188354564 188354564 188354564 10.1186/s12871-025-03336-z 188354564 ppf: 1 ppct: 9 formats: tig: atl: Hypotension prediction index smart alerts and trends to improve compliance with goal-directed hemodynamic therapy: a feasibility study. aug: au: Guerra-Londono, Carlos E. Hand, William R. Fleming, Neal Davis, Jeffrey Treggiari, Miriam M. Dunkman, W. Jonathan Kumar, Sathish S. Khanna, Ashish K. Yang, Jen-Ting Domino, Karen B. affil: https://ror.org/02kwnkm68 Department of Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, 2799 W Grand Boulevard, 4th Floor, 48323, Detroit, MI, USA sug: subj: Hypotension Diagnosis Hemodynamics Algorithms Surgery, Elective Intraoperative Monitoring Prediction Models Human Male Female Middle Age Aged Multicenter Studies Multimethod Studies Pilot Studies Confidence Intervals Heart Rate Surgery, Laparoscopic Phenylephrine Vasopressins Norepinephrine Crystalloid Solutions Colloids Data Analysis Software Scales Funding Source Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Goal-directed hemodynamic therapy (GDHT) and Hypotension Prediction Index (HPI, Edwards Lifesciences, Irvine, CA) technology are used to improve post-operative patient outcomes. Trials evaluating GDHT are frequently limited by poor algorithm compliance. The Acumen HPI Software incorporates smart trends and alerts that highlight the probable mechanism(s) of hypotension and facilitate compliance with the GDHT algorithm. We hypothesized that prompts from the Acumen HPI Smart Alerts would improve compliance to a GDHT algorithm during moderate-to‐high‐risk elective noncardiac surgery. Methods: This IRB-approved, multicenter, mixed-methods, single‐arm feasibility trial included adults undergoing elective, moderate-to-high-risk noncardiac surgery requiring intra-arterial blood pressure monitoring. The HPI-guided GDHT algorithm included actionable trends at HPI > 50 and automated HPI Smart Alert notifications at HPI ≥ 85, displaying the most likely hypotension mechanism(s). The primary outcome was the proportion of HPI notifications resulting in timely algorithm-concordant interventions. The sample size was estimated to achieve a true compliance rate of at least 75% with a 95% confidence level above 60%. Results: A total of 122 subjects were included. The enrollment among centers was balanced. The overall compliance rate was 77.1% (95% CI: 74.5–79.6%). The median area under the curve, time-weighted average, and minutes of hypotension below 65 mmHg were 8.8 (0.3, 33.7) mmHg*min, 0.0 (0.0, 0.1) mmHg, and 2.9 (0.4, 8.7) minutes, respectively. Conclusions: This study demonstrated the potential for HPI Smart Alerts to improve compliance with an intraoperative GDHT algorithm in adults undergoing moderate to high-risk non-cardiac surgery. A low burden of intra-operative hypotension was observed, suggesting potential decreases in other associated adverse outcomes. Larger-scale randomized studies are warranted. Trial registration: This trial was retrospectively registered at ClinicalTrials.gov on 14 July 2023 (NCT05957406). pubtype: Academic Journal doctype: algorithm pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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