Hypotension Prediction Index for Prevention of Intraoperative Hypotension in Patients Undergoing General Anesthesia: A Randomized Controlled Trial

Abstract Background Intraoperative hypotension is a common side effect of general anaesthesia. Here we examined whether the Hypotension Prediction Index, a novel warning system, reduce the severity and duration of intraoperative hypotension during general anaesthesia surgery. Methods This randomized controlled trial was conducted at the anesthesiology department of a tertiary referral hospital in Taipei, Taiwan. Sixty eligible patients were randomized 1:1 to hemodynamic management with Hypotension Prediction Index guidance (intervention group) or standard of care (control group). Intraoperative hypotension treatment was initiated at a Hypotension Prediction Index > 85 in the intervention and a mean arterial pressure < 65 mmHg in the control group. Primary outcome was the severity of hypotension, defined as a time-weighted average mean arterial pressure < 65mmHg. Secondary outcomes were postoperative complications and mortality within 30 postoperative days. Results The intervention group exhibited a significantly lower median time-weighted average mean arterial pressure < 65mmHg (0.02 [Q1, Q3: 0.003, 0.08] vs. 0.37 [0.20, 0.58], P < 0.001) and fewer postoperative gastrointestinal symptoms (6 vs. 14, P = 0.028). The median duration from alarm to first intraoperative hypotension treatment in the intervention group (42.78 [20.4, 79.0] s) was significantly shorter than that silent alarm to first treatment in the control group (200.16 [99.7, 261.8] s) group ( P < 0.001). Conclusions Hypotension Prediction Index guidance appears to be effective in preventing intraoperative hypotension and reducing postoperative gastrointestinal symptoms. Trial registration ClinicalTrials.gov (NCT04966364); 202105065RINA; Date of registration: July 19, 2021; The recruitment date of the first patient: July 22, 2021