Javier Ripollés-Melchor, José L Tomé-Roca, Andrés Zorrilla-Vaca, César Aldecoa, María J Colomina, Eva Bassas-Parga, Juan V Lorente, Alicia Ruiz-Escobar, Laura Carrasco-Sánchez, Marc Sadurni-Sarda, Eva Rivas, Jaume Puig, Elizabeth Agudelo-Montoya, Sabela Del Rio-Fernández, Daniel García-López, Ana B Adell-Pérez, Antonio Guillen, Rocío Venturoli-Ojeda, Bartolomé Fernández-Torres, Ane Abad-Motos, Irene Mojarro, José L Garrido-Calmaestra, Jesús Fernanz-Antón, Ana Pedregosa-Sanz, Luisa Cueva-Castro, Miren A Echevarria-Correas, Montserrat Mallol, María M Olvera-García, Rosalía Navarro-Pérez, Paula Fernández-Valdés-Bango, Javier García-Fernández, Ángel V Espinosa, Hussein Abu Khudair, Ángel Becerra-Bolaños, Yolanda Díez-Remesal, María A Fuentes-Pradera, Miguel A Valbuena-Bueno, Begoña Quintana-Villamandos, Jordi Llorca-García, Ignacio Fernández-López, Álvaro Ocón-Moreno, Sandra L Martín-Infantes, Javier M Valiente-Lourtau, Marta Amelburu-Egoscozabal, Hugo Rivera-Ramos, Alfredo Abad-Gurumeta, Manuel I Monge-García
{"title":"Hemodynamic Management guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial.","authors":"Javier Ripollés-Melchor, José L Tomé-Roca, Andrés Zorrilla-Vaca, César Aldecoa, María J Colomina, Eva Bassas-Parga, Juan V Lorente, Alicia Ruiz-Escobar, Laura Carrasco-Sánchez, Marc Sadurni-Sarda, Eva Rivas, Jaume Puig, Elizabeth Agudelo-Montoya, Sabela Del Rio-Fernández, Daniel García-López, Ana B Adell-Pérez, Antonio Guillen, Rocío Venturoli-Ojeda, Bartolomé Fernández-Torres, Ane Abad-Motos, Irene Mojarro, José L Garrido-Calmaestra, Jesús Fernanz-Antón, Ana Pedregosa-Sanz, Luisa Cueva-Castro, Miren A Echevarria-Correas, Montserrat Mallol, María M Olvera-García, Rosalía Navarro-Pérez, Paula Fernández-Valdés-Bango, Javier García-Fernández, Ángel V Espinosa, Hussein Abu Khudair, Ángel Becerra-Bolaños, Yolanda Díez-Remesal, María A Fuentes-Pradera, Miguel A Valbuena-Bueno, Begoña Quintana-Villamandos, Jordi Llorca-García, Ignacio Fernández-López, Álvaro Ocón-Moreno, Sandra L Martín-Infantes, Javier M Valiente-Lourtau, Marta Amelburu-Egoscozabal, Hugo Rivera-Ramos, Alfredo Abad-Gurumeta, Manuel I Monge-García","doi":"10.1097/ALN.0000000000005355","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Postoperative acute kidney injury (AKI) after major abdominal surgery leads to poor outcomes. The Hypotension Prediction Index (HPI) may aid in managing intraoperative hemodynamic instability. This study assessed if HPI-guided therapy reduces moderate-to-severe AKI incidence in moderate-to-high-risk elective abdominal surgery patients.</p><p><strong>Methods: </strong>This multicenter randomized trial was conducted from October 2022 to February 2024 across 28 hospitals evaluating HPI-guided management compared to a wide range of real-world hemodynamic approaches. 917 patients (≥65 years or >18 years with ASA status >II) undergoing moderate-to-high-risk elective abdominal surgery were included in the intention-to-treat analysis. HPI-guided management triggered interventions when the HPI exceeded 80, using fluids and/or vasopressors/inotropes based on hemodynamic data. The primary outcome was the incidence of moderate-to-severe AKI within the first 7 days after surgery. Secondary outcomes included overall complications, the need for renal replacement therapy, duration of hospital stay, and 30-day mortality.</p><p><strong>Results: </strong>Median age was 71 years (IQR, 65-77) in the HPI group and 70 years (IQR, 63-76) in standard care group. ASA status III/IV was 58.3% (268/459) in the HPI group and 57.9% (263/458) in standard care group. The incidence of moderate-to-severe AKI was 6.1% (28/459) in the HPI group and 7.0% (32/458) in the standard care group (RR 0.89, 95% 0.54-1.49; P=0.66). Overall complications occurred in 31.9% (146/459) of the HPI group and 29.7% (136/458) of the standard care group (RR 1.08, 95% CI 0.85-1.37; P = 0.52). The incidence of renal replacement therapy did not differ between groups. Median length of hospital stay was 6 days (IQR, 4-10) in both groups. The 30-day mortality was 1.1% (5/459) in the HPI group versus 0.9% (4/458) in standard care group (RR 1.35, 95% CI 0.36-5.10; P = 0.66).</p><p><strong>Conclusions: </strong>HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.</p><p><strong>Clinicaltrialsgov identifier: </strong>NCT05569265.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1000,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/ALN.0000000000005355","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Postoperative acute kidney injury (AKI) after major abdominal surgery leads to poor outcomes. The Hypotension Prediction Index (HPI) may aid in managing intraoperative hemodynamic instability. This study assessed if HPI-guided therapy reduces moderate-to-severe AKI incidence in moderate-to-high-risk elective abdominal surgery patients.
Methods: This multicenter randomized trial was conducted from October 2022 to February 2024 across 28 hospitals evaluating HPI-guided management compared to a wide range of real-world hemodynamic approaches. 917 patients (≥65 years or >18 years with ASA status >II) undergoing moderate-to-high-risk elective abdominal surgery were included in the intention-to-treat analysis. HPI-guided management triggered interventions when the HPI exceeded 80, using fluids and/or vasopressors/inotropes based on hemodynamic data. The primary outcome was the incidence of moderate-to-severe AKI within the first 7 days after surgery. Secondary outcomes included overall complications, the need for renal replacement therapy, duration of hospital stay, and 30-day mortality.
Results: Median age was 71 years (IQR, 65-77) in the HPI group and 70 years (IQR, 63-76) in standard care group. ASA status III/IV was 58.3% (268/459) in the HPI group and 57.9% (263/458) in standard care group. The incidence of moderate-to-severe AKI was 6.1% (28/459) in the HPI group and 7.0% (32/458) in the standard care group (RR 0.89, 95% 0.54-1.49; P=0.66). Overall complications occurred in 31.9% (146/459) of the HPI group and 29.7% (136/458) of the standard care group (RR 1.08, 95% CI 0.85-1.37; P = 0.52). The incidence of renal replacement therapy did not differ between groups. Median length of hospital stay was 6 days (IQR, 4-10) in both groups. The 30-day mortality was 1.1% (5/459) in the HPI group versus 0.9% (4/458) in standard care group (RR 1.35, 95% CI 0.36-5.10; P = 0.66).
Conclusions: HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.
期刊介绍：
With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.
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