Intraoperative Hypotension Prediction: Current Methods, Controversies, and Research Outlook

Intraoperative hypotension prediction has been increasingly emphasized due to its potential clinical value in reducing organ injury and the broad availability of large-scale patient datasets and powerful machine learning tools. Hypotension prediction methods can mitigate low blood pressure exposure time. However, they have yet to be convincingly demonstrated to improve objective outcomes; furthermore, they have recently become controversial. This review presents the current state of intraoperative hypotension prediction and makes recommendations on future research. We begin by overviewing the current hypotension prediction methods, which generally rely on the prevailing mean arterial pressure as one of the important input variables and typically show good sensitivity and specificity but low positive predictive value in forecasting near-term acute hypotensive events. We make specific suggestions on improving the definition of acute hypotensive events and evaluating hypotension prediction methods, along with general proposals on extending the methods to predict reduced blood flow and treatment effects. We present a start of a risk-benefit analysis of hypotension prediction methods in clinical practice. We conclude by coalescing this analysis with the current evidence to offer an outlook on prediction methods for intraoperative hypotension. A shift in research toward tailoring hypotension prediction methods to individual patients and pursuing methods to predict appropriate treatment in response to hypotension appear most promising to improve outcomes.