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Intraoperative hemodynamic management in abdominal aortic surgery guided by the Hypotension Prediction Index: the

Enrico Giustiniano1, Fulvio Nisi2,3, Federica Ferrod4

  • 1Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.

Journal of Anesthesia, Analgesia and Critical Care
|February 13, 2025
PubMed

Insights

This study shows that using a hemodynamic management algorithm with the Hypotension Prediction Index (HPI) effectively reduced intraoperative hypotension during open abdominal aortic aneurysm repair, improving patient outcomes.

Area of Science:

  • Anesthesiology and Critical Care Medicine
  • Cardiovascular Surgery
  • Medical Technology and Devices

Background:

  • Intraoperative hypotension (IOH) is linked to increased postoperative complications, particularly during major vascular surgery.
  • Predictive algorithms for IOH are crucial for improving surgical outcomes.
  • Open abdominal aortic aneurysm repair presents a high risk for hypotensive events.

Purpose of the Study:

  • To investigate the efficacy of a hemodynamic management algorithm incorporating the Hypotension Prediction Index (HPI) in reducing IOH during open abdominal aortic aneurysm repair.
  • To assess the impact of the Hemosphere™ platform on minimizing hypotensive episodes and their severity.
  • To evaluate the algorithm's ability to limit the incidence and duration of intraoperative hypotension.

Main Methods:

  • A multi-center observational study enrolled 53 patients undergoing elective open abdominal aortic aneurysm repair.
  • A hemodynamic protocol utilizing the Acumen-HPI Hemosphere™ platform, including HPI, Ea-dyn, and dP/dt parameters, was implemented.
  • The primary endpoint was cumulative intraoperative hypotension time <10% of surgical time; secondary endpoints included incidence of hypotensive events and time-weighted averages of mean arterial pressure (MAP) <65 mmHg (TWA65) and <50 mmHg (TWA50).

Main Results:

  • The primary endpoint was successfully achieved, with intraoperative hypotension time <10% of surgical time recorded at 5% [1-10%].
  • Targeted time-weighted averages for MAP <65 mmHg (TWA65) and <50 mmHg (TWA50) were met, with TWA65 = 0.26 [0.04-0.65] mmHg and TWA50 = 0.00 [0.00-0.01] mmHg.
  • The algorithm demonstrated success in limiting both the incidence and severity of intraoperative hypotension.

Conclusions:

  • The implemented hemodynamic management algorithm, guided by the HPI and Hemosphere™ platform, effectively limited intraoperative hypotension during open abdominal aortic repair.
  • This approach shows promise in mitigating a significant risk factor for postoperative complications in high-risk surgical procedures.
  • The study supports the use of predictive hemodynamic monitoring for optimizing patient care during complex surgeries.
Abstract

Keywords:
Abdominal aortaHemodynamic monitoringIntraoperative hypo-tensionOpen aortic repairVascular surgery

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