Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT)
Karim Kouz,
Manuel Ignacio Monge García,
Elisabetta Cerutti,
Ivana Lisanti,
Gaetano Draisci,
Luciano Frassanito,
Michael Sander,
Amir Ali Akbari,
Ulrich H. Frey,
Carla Davina Grundmann,
Simon James Davies,
Abele Donati,
Javier Ripolles-Melchor,
Daniel García-López,
Benjamin Vojnar,
Étienne Gayat,
Eric Noll,
Peter Bramlage,
Bernd Saugel
Affiliations
Karim Kouz
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Manuel Ignacio Monge García
Unidad de Cuidados Intensivos, Hospital Universitario SAS Jerez, Jerez de La Frontera, Spain
Elisabetta Cerutti
Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
Ivana Lisanti
Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
Gaetano Draisci
Department of Emergency, Intensive Care Medicine and Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
Luciano Frassanito
Department of Emergency, Intensive Care Medicine and Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
Michael Sander
Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany
Amir Ali Akbari
Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany
Ulrich H. Frey
Department of Anesthesiology, Intensive Care, Pain and Palliative Care, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
Carla Davina Grundmann
Department of Anesthesiology, Intensive Care, Pain and Palliative Care, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
Simon James Davies
York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK; Centre for Health and Population Sciences, Hull York Medical School, York, UK
Abele Donati
Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
Javier Ripolles-Melchor
Anesthesia and Critical Care Department, Hospital Universitario Infanta Leonor, Madrid, Spain
Daniel García-López
Department of Anaesthesiology and Reanimation, University Hospital Marqués de Valdecilla, Santander, Spain
Benjamin Vojnar
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany
Étienne Gayat
Université Paris Cité, INSERM, Paris, France; Department of Anesthesia and Critical Care Medicine, Hôpital Lariboisière, Paris, France
Eric Noll
Department of Anesthesiology and Intensive Care, Hôpital de Hautepierre, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
Peter Bramlage
Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
Bernd Saugel
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA; Corresponding author. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Background: Intraoperative hypotension is associated with organ injury. Current intraoperative arterial pressure management is mainly reactive. Predictive haemodynamic monitoring may help clinicians reduce intraoperative hypotension. The Acumen™ Hypotension Prediction Index software (HPI-software) (Edwards Lifesciences, Irvine, CA, USA) was developed to predict hypotension. We built up the European multicentre, prospective, observational EU HYPROTECT Registry to describe the incidence, duration, and severity of intraoperative hypotension when using HPI-software monitoring in patients having noncardiac surgery. Methods: We enrolled 749 patients having elective major noncardiac surgery in 12 medical centres in five European countries. Patients were monitored using the HPI-software. We quantified hypotension using the time-weighted average MAP <65 mm Hg (primary endpoint), the proportion of patients with at least one ≥1 min episode of a MAP <65 mm Hg, the number of ≥1 min episodes of a MAP <65 mm Hg, and duration patients spent below a MAP of 65 mm Hg. Results: We included 702 patients in the final analysis. The median time-weighted average MAP <65 mm Hg was 0.03 (0.00–0.20) mm Hg. In addition, 285 patients (41%) had no ≥1 min episode of a MAP <65 mm Hg; 417 patients (59%) had at least one. The median number of ≥1 min episodes of a MAP <65 mm Hg was 1 (0–3). Patients spent a median of 2 (0–9) min below a MAP of 65 mm Hg. Conclusions: The median time-weighted average MAP <65 mm Hg was very low in patients in this registry. This suggests that using HPI-software monitoring may help reduce the duration and severity of intraoperative hypotension in patients having noncardiac surgery.
