Proactive haemodynamic management using the hypotension prediction index during caesarean section: a randomised...

Area of Science:

• Obstetric Anesthesiology
• Cardiovascular Monitoring
• Machine Learning in Medicine

Background:

• Intra-operative hypotension is a frequent complication during caesarean sections, potentially leading to adverse maternal outcomes like nausea and vomiting.
• Current monitoring methods (oscillometric, continuous non-invasive arterial pressure) allow for reactive treatment of hypotension.
• The hypotension prediction index (HPI) offers a machine learning-based, proactive approach to haemodynamic management.

Purpose of the Study:

• To investigate if HPI-guided management could decrease the incidence of intra-operative hypotension during caesarean sections.
• To compare the efficacy of HPI monitoring against oscillometric and continuous non-invasive arterial pressure monitoring in managing haemodynamics.
• To assess the impact of different monitoring strategies on maternal adverse effects.

Main Methods:

• Randomized controlled trial involving patients undergoing elective caesarean section under spinal anaesthesia.
• Three groups were assigned: oscillometric blood pressure monitoring, continuous non-invasive arterial pressure monitoring, and HPI-guided monitoring.
• Hypotension defined as mean arterial pressure < 65 mmHg, treated with noradrenaline; hypertension defined as ≥ 100 mmHg.

Main Results:

• The HPI group demonstrated significantly lower time-weighted average hypotension (0.08 mmHg) compared to oscillometric (0.89 mmHg) and continuous non-invasive arterial pressure (0.30 mmHg) groups (p < 0.001).
• The oscillometric group reported a higher incidence of maternal nausea (43/59) and vomiting (13/59) compared to the other two groups.
• No significant increase in intra-operative hypertension was noted in the HPI group.

Conclusions:

• HPI-guided management effectively reduces intra-operative hypotension in caesarean sections.
• This proactive monitoring strategy improves haemodynamic stability and reduces maternal adverse effects.
• HPI represents a valuable tool for optimising anaesthetic care in obstetric patients.