Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT)
Karim Kouz , Manuel Ignacio Monge García , Elisabetta Cerutti , Ivana Lisanti , Gaetano Draisci , Luciano Frassanito , Michael Sander , Amir Ali Akbari , Ulrich H. Frey , Carla Davina Grundmann , Simon James Davies , Abele Donati , Javier Ripolles-Melchor , Daniel García-López , Benjamin Vojnar , Étienne Gayat , Eric Noll , Peter Bramlage , Bernd Saugel
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引用次数: 2
Abstract
Background
Intraoperative hypotension is associated with organ injury. Current intraoperative arterial pressure management is mainly reactive. Predictive haemodynamic monitoring may help clinicians reduce intraoperative hypotension. The Acumen™ Hypotension Prediction Index software (HPI-software) (Edwards Lifesciences, Irvine, CA, USA) was developed to predict hypotension. We built up the European multicentre, prospective, observational EU HYPROTECT Registry to describe the incidence, duration, and severity of intraoperative hypotension when using HPI-software monitoring in patients having noncardiac surgery.
Methods
We enrolled 749 patients having elective major noncardiac surgery in 12 medical centres in five European countries. Patients were monitored using the HPI-software. We quantified hypotension using the time-weighted average MAP <65 mm Hg (primary endpoint), the proportion of patients with at least one ≥1 min episode of a MAP <65 mm Hg, the number of ≥1 min episodes of a MAP <65 mm Hg, and duration patients spent below a MAP of 65 mm Hg.
Results
We included 702 patients in the final analysis. The median time-weighted average MAP <65 mm Hg was 0.03 (0.00–0.20) mm Hg. In addition, 285 patients (41%) had no ≥1 min episode of a MAP <65 mm Hg; 417 patients (59%) had at least one. The median number of ≥1 min episodes of a MAP <65 mm Hg was 1 (0–3). Patients spent a median of 2 (0–9) min below a MAP of 65 mm Hg.
Conclusions
The median time-weighted average MAP <65 mm Hg was very low in patients in this registry. This suggests that using HPI-software monitoring may help reduce the duration and severity of intraoperative hypotension in patients having noncardiac surgery.
背景:术中低血压与器官损伤有关。目前术中动脉压管理主要是反应性的。预测血流动力学监测可以帮助临床医生减少术中低血压。Acumen™低血压预测指数软件(HPI-software) (Edwards Lifesciences, Irvine, CA, USA)被开发用来预测低血压。我们建立了欧洲多中心、前瞻性、观察性的EU HYPROTECT注册表,以描述在非心脏手术患者中使用hpi软件监测时术中低血压的发生率、持续时间和严重程度。方法:我们在欧洲5个国家的12个医疗中心招募了749例选择性非心脏大手术患者。采用hpi软件对患者进行监测。我们使用时间加权平均MAP <65毫米汞柱(主要终点)、至少一次MAP <65毫米汞柱≥1分钟发作的患者比例、MAP <65毫米汞柱≥1分钟发作的次数以及患者在MAP <65毫米汞柱低于65毫米汞柱的持续时间来量化低血压。结果最终分析纳入702例患者。MAP <65 mm Hg的中位时间加权平均值为0.03 (0.00-0.20)mm Hg。此外,285名患者(41%)没有≥1分钟的MAP <65 mm Hg发作;417例患者(59%)至少有一种。MAP <65 mm Hg≥1分钟发作的中位数为1(0-3)。患者MAP低于65 mm Hg的中位时间为2(0-9)分钟。结论在该登记的患者中位时间加权平均MAP <65 mm Hg非常低。这表明使用hpi软件监测可能有助于减少非心脏手术患者术中低血压的持续时间和严重程度。