Intraoperative Hypotension Prediction: Current Methods, Controversies, and Research Outlook.

Ramakrishna Mukkamala,Michael P Schnetz,Ashish K Khanna,Aman Mahajan
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Abstract

Intraoperative hypotension prediction has been increasingly emphasized due to its potential clinical value in reducing organ injury and the broad availability of large-scale patient datasets and powerful machine learning tools. Hypotension prediction methods can mitigate low blood pressure exposure time. However, they have yet to be convincingly demonstrated to improve objective outcomes; furthermore, they have recently become controversial. This review presents the current state of intraoperative hypotension prediction and makes recommendations on future research. We begin by overviewing the current hypotension prediction methods, which generally rely on the prevailing mean arterial pressure as one of the important input variables and typically show good sensitivity and specificity but low positive predictive value in forecasting near-term acute hypotensive events. We make specific suggestions on improving the definition of acute hypotensive events and evaluating hypotension prediction methods, along with general proposals on extending the methods to predict reduced blood flow and treatment effects. We present a start of a risk-benefit analysis of hypotension prediction methods in clinical practice. We conclude by coalescing this analysis with the current evidence to offer an outlook on prediction methods for intraoperative hypotension. A shift in research toward tailoring hypotension prediction methods to individual patients and pursuing methods to predict appropriate treatment in response to hypotension appear most promising to improve outcomes.
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术中低血压预测:当前方法、争议和研究展望》。
由于术中低血压预测在减少器官损伤方面具有潜在的临床价值,而且大规模患者数据集和强大的机器学习工具的广泛可用性,术中低血压预测越来越受到重视。低血压预测方法可以缩短低血压暴露时间。然而,这些方法尚未令人信服地证明能改善客观预后;此外,这些方法最近还引起了争议。本综述介绍了术中低血压预测的现状,并对未来的研究提出了建议。我们首先概述了目前的低血压预测方法,这些方法通常依赖于当时的平均动脉压作为重要的输入变量之一,在预测近期急性低血压事件方面通常表现出良好的灵敏度和特异性,但阳性预测值较低。我们就改进急性低血压事件的定义和评估低血压预测方法提出了具体建议,并就扩展方法以预测血流量减少和治疗效果提出了一般性建议。我们开始对临床实践中的低血压预测方法进行风险效益分析。最后,我们将这一分析与当前的证据相结合,对术中低血压的预测方法进行了展望。研究方向应转向为个体患者量身定制低血压预测方法,并寻求针对低血压预测适当治疗的方法,这似乎是最有希望改善预后的方法。
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