The Hypotension Prediction Index in Major Abdominal Surgery

The fundamental aspect of the anesthetics perioperative management is to maintain hemodynamic stability, with special attention on the avoidance or reduction of the episodes of intraoperative hypotension (IOH). The incidence of intraoperative hypotension is related to an increased rate of perioperative morbidity and mortality. Even a short period of hypotension can be related to an increased risk of postoperative stroke, myocardial injury and acute kidney injury. Patients undergoing major abdominal surgery are at a high-risk of IOH because such surgeries typically require more than 2h to complete and require blood transfusion or inotrope administration. Hemodynamic monitoring and the use of goal directed therapy protocols helps to diminish the incidence of perioperative complications, however the hypotension management remains a reactive approach, an intervention is made when the hypotension has already occured. The Hypotension Prediction Index is an machine learning algorithm which allows to predict the episodes of hypotension and intervene before mean arterial pressure drops below 65 mmHg. The aim of the current study is to compare the rate of hypotension in patients undergoing major abdominal surgery with the arterial pressure cardiac output algorithm and the hypotension prediction index algorithm.

• Time weighed average of hypotension below 50 mmHg [Срок оценки: "From the beginning of the anesthesia to the end of anesthesia (from induction - start of anesthesia to end of anesthesia - discharge from the post anesthesia department), assessed up to 30 days]
• Time weighed average of hypertension above 90 mmHg [Срок оценки: "From the beginning of the anesthesia to the end of anesthesia (from induction - start of anesthesia to end of anesthesia - discharge from the post anesthesia department), assessed up to 30 days]
• Time weighed average of hypertension above 100 mmHg [Срок оценки: "From the beginning of the anesthesia to the end of anesthesia (from induction - start of anesthesia to end of anesthesia - discharge from the post anesthesia department), assessed up to 30 days]
• 30 day mortality [Срок оценки: 30 consecutive days starting from the day of the surgery]
• Length of hospitalisation [Срок оценки: From the date of randomisation to the date of hospital discharge or death, whichever comes first, assessed up to 30 days]
• Myocardial injury evaluated by postoperative troponin levels [Срок оценки: First, second and fifth postoperative day]
• Kidney injury evaluated by creatinine levels [Срок оценки: First, second and fifth postoperative day]
• Intraoperative fluid dose [Срок оценки: "From the beginning of the anesthesia to the end of anesthesia (from induction - start of anesthesia to end of anesthesia - discharge from the post anesthesia department), assessed up to 30 days]
• Intraoperative vasopressor dose [Срок оценки: "From the beginning of the anesthesia to the end of anesthesia (from induction - start of anesthesia to end of anesthesia - discharge from the post anesthesia department), assessed up to 30 days]
• Rate of intra and postoperative atrial fibrillation [Срок оценки: "From the beginning of the anesthesia to the end of anesthesia (from induction - start of anesthesia to end of anesthesia - discharge from the post anesthesia department), assessed up to 30 days]