Hypotension Prediction Index versus Mean Arterial Pressure Alarm for Preventing Intraoperative Hypotension in Elective Noncardiac Surgery: A Randomized Controlled Trial.
Anna A Florax, Marijn P Mulder, Roland P van Ieperen et al.
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In 30 seconds
This single-center, blinded randomized controlled trial compared a mean arterial pressure (MAP) alarm below 72 mmHg with a Hypotension Prediction Index (HPI) alarm above 85 in adults undergoing moderate- or high-risk elective noncardiac surgery with continuous arterial pressure monitoring. Among 143 participants in the final analysis, the MAP alarm was noninferior to HPI for the primary outcome, area under the threshold for MAP below 65 mmHg. Median values were 3.75 [0.00 to 22.62] mmHg ⋅ min and 4.00 [0.00 to 19.00] mmHg ⋅ min, respectively; secondary outcomes did not differ.
Key findings
- Median area under the MAP threshold below 65 mmHg was 3.75 [0.00 to 22.62] mmHg ⋅ min with the MAP alarm and 4.00 [0.00 to 19.00] mmHg ⋅ min with HPI.
- The log-transformed mean difference was 0.03 (95% CI, -0.24 to 0.29), meeting the predefined noninferiority criterion.
- No differences were observed in secondary hemodynamic measures, alarm characteristics, patient outcomes, or administered vasoactive medications and fluids.
Why it matters
The trial suggests that a straightforward MAP threshold can provide a similar degree of intraoperative hypotension prevention to a predictive index in the studied surgical population. This is relevant because the two approaches differ in complexity and availability, while the study found no observed differences in patient outcomes or treatment use. The findings inform evaluation of alarm strategies but do not establish effects beyond the trial setting.
What to keep in mind
The trial was single-center, and the final analysis included 143 participants. It studied adults undergoing moderate- or high-risk elective noncardiac surgery with continuous arterial pressure monitoring.