Hemodynamic Management guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial
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...
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| creator | Ripollés-Melchor, Javier Tomé-Roca, José L Zorrilla-Vaca, Andrés Aldecoa, César Colomina, María J Bassas-Parga, Eva Lorente, Juan V Ruiz-Escobar, Alicia Carrasco-Sánchez, Laura Sadurni-Sarda, Marc Rivas, Eva Puig, Jaume Agudelo-Montoya, Elizabeth Del Rio-Fernández, Sabela García-López, Daniel Adell-Pérez, Ana B Guillen, Antonio Venturoli-Ojeda, Rocío Fernández-Torres, Bartolomé Abad-Motos, Ane Mojarro, Irene Garrido-Calmaestra, José L Fernanz-Antón, Jesús Pedregosa-Sanz, Ana Cueva-Castro, Luisa Echevarria-Correas, Miren A Mallol, Montserrat Olvera-García, María M Navarro-Pérez, Rosalía Fernández-Valdés-Bango, Paula García-Fernández, Javier Espinosa, Ángel V Abu Khudair, Hussein Becerra-Bolaños, Ángel Díez-Remesal, Yolanda Fuentes-Pradera, María A Valbuena-Bueno, Miguel A Quintana-Villamandos, Begoña Llorca-García, Jordi Fernández-López, Ignacio Ocón-Moreno, Álvaro Martín-Infantes, Sandra L Valiente-Lourtau, Javier M Amelburu-Egoscozabal, Marta Rivera-Ramos, Hugo Abad-Gurumeta, Alfredo Monge-García, Manuel I |
| description | 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.
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.
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).
HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.
NCT05569265. |
| doi_str_mv | 10.1097/ALN.0000000000005355 |
| format | Article |
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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.
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).
HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.
NCT05569265.</description><identifier>ISSN: 0003-3022</identifier><identifier>ISSN: 1528-1175</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/ALN.0000000000005355</identifier><identifier>PMID: 39746186</identifier><language>eng</language><publisher>United States</publisher><ispartof>Anesthesiology (Philadelphia), 2025-01</ispartof><rights>Copyright © 2025 American Society of Anesthesiologists. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0002-1958-9316</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39746186$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ripollés-Melchor, Javier</creatorcontrib><creatorcontrib>Tomé-Roca, José L</creatorcontrib><creatorcontrib>Zorrilla-Vaca, Andrés</creatorcontrib><creatorcontrib>Aldecoa, César</creatorcontrib><creatorcontrib>Colomina, María J</creatorcontrib><creatorcontrib>Bassas-Parga, Eva</creatorcontrib><creatorcontrib>Lorente, Juan V</creatorcontrib><creatorcontrib>Ruiz-Escobar, Alicia</creatorcontrib><creatorcontrib>Carrasco-Sánchez, Laura</creatorcontrib><creatorcontrib>Sadurni-Sarda, Marc</creatorcontrib><creatorcontrib>Rivas, Eva</creatorcontrib><creatorcontrib>Puig, Jaume</creatorcontrib><creatorcontrib>Agudelo-Montoya, Elizabeth</creatorcontrib><creatorcontrib>Del Rio-Fernández, Sabela</creatorcontrib><creatorcontrib>García-López, Daniel</creatorcontrib><creatorcontrib>Adell-Pérez, Ana B</creatorcontrib><creatorcontrib>Guillen, Antonio</creatorcontrib><creatorcontrib>Venturoli-Ojeda, Rocío</creatorcontrib><creatorcontrib>Fernández-Torres, Bartolomé</creatorcontrib><creatorcontrib>Abad-Motos, Ane</creatorcontrib><creatorcontrib>Mojarro, Irene</creatorcontrib><creatorcontrib>Garrido-Calmaestra, José L</creatorcontrib><creatorcontrib>Fernanz-Antón, Jesús</creatorcontrib><creatorcontrib>Pedregosa-Sanz, Ana</creatorcontrib><creatorcontrib>Cueva-Castro, Luisa</creatorcontrib><creatorcontrib>Echevarria-Correas, Miren A</creatorcontrib><creatorcontrib>Mallol, Montserrat</creatorcontrib><creatorcontrib>Olvera-García, María M</creatorcontrib><creatorcontrib>Navarro-Pérez, Rosalía</creatorcontrib><creatorcontrib>Fernández-Valdés-Bango, Paula</creatorcontrib><creatorcontrib>García-Fernández, Javier</creatorcontrib><creatorcontrib>Espinosa, Ángel V</creatorcontrib><creatorcontrib>Abu Khudair, Hussein</creatorcontrib><creatorcontrib>Becerra-Bolaños, Ángel</creatorcontrib><creatorcontrib>Díez-Remesal, Yolanda</creatorcontrib><creatorcontrib>Fuentes-Pradera, María A</creatorcontrib><creatorcontrib>Valbuena-Bueno, Miguel A</creatorcontrib><creatorcontrib>Quintana-Villamandos, Begoña</creatorcontrib><creatorcontrib>Llorca-García, Jordi</creatorcontrib><creatorcontrib>Fernández-López, Ignacio</creatorcontrib><creatorcontrib>Ocón-Moreno, Álvaro</creatorcontrib><creatorcontrib>Martín-Infantes, Sandra L</creatorcontrib><creatorcontrib>Valiente-Lourtau, Javier M</creatorcontrib><creatorcontrib>Amelburu-Egoscozabal, Marta</creatorcontrib><creatorcontrib>Rivera-Ramos, Hugo</creatorcontrib><creatorcontrib>Abad-Gurumeta, Alfredo</creatorcontrib><creatorcontrib>Monge-García, Manuel I</creatorcontrib><creatorcontrib>HYT Study Group</creatorcontrib><creatorcontrib>on behalf of the HYT Study Group</creatorcontrib><title>Hemodynamic Management guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>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.
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.
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).
HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.
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Rosalía</creatorcontrib><creatorcontrib>Fernández-Valdés-Bango, Paula</creatorcontrib><creatorcontrib>García-Fernández, Javier</creatorcontrib><creatorcontrib>Espinosa, Ángel V</creatorcontrib><creatorcontrib>Abu Khudair, Hussein</creatorcontrib><creatorcontrib>Becerra-Bolaños, Ángel</creatorcontrib><creatorcontrib>Díez-Remesal, Yolanda</creatorcontrib><creatorcontrib>Fuentes-Pradera, María A</creatorcontrib><creatorcontrib>Valbuena-Bueno, Miguel A</creatorcontrib><creatorcontrib>Quintana-Villamandos, Begoña</creatorcontrib><creatorcontrib>Llorca-García, Jordi</creatorcontrib><creatorcontrib>Fernández-López, Ignacio</creatorcontrib><creatorcontrib>Ocón-Moreno, Álvaro</creatorcontrib><creatorcontrib>Martín-Infantes, Sandra L</creatorcontrib><creatorcontrib>Valiente-Lourtau, Javier M</creatorcontrib><creatorcontrib>Amelburu-Egoscozabal, Marta</creatorcontrib><creatorcontrib>Rivera-Ramos, Hugo</creatorcontrib><creatorcontrib>Abad-Gurumeta, Alfredo</creatorcontrib><creatorcontrib>Monge-García, Manuel I</creatorcontrib><creatorcontrib>HYT Study Group</creatorcontrib><creatorcontrib>on behalf of the HYT Study Group</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ripollés-Melchor, Javier</au><au>Tomé-Roca, José L</au><au>Zorrilla-Vaca, Andrés</au><au>Aldecoa, César</au><au>Colomina, María J</au><au>Bassas-Parga, Eva</au><au>Lorente, Juan V</au><au>Ruiz-Escobar, Alicia</au><au>Carrasco-Sánchez, Laura</au><au>Sadurni-Sarda, Marc</au><au>Rivas, Eva</au><au>Puig, Jaume</au><au>Agudelo-Montoya, Elizabeth</au><au>Del Rio-Fernández, Sabela</au><au>García-López, Daniel</au><au>Adell-Pérez, Ana B</au><au>Guillen, Antonio</au><au>Venturoli-Ojeda, Rocío</au><au>Fernández-Torres, Bartolomé</au><au>Abad-Motos, Ane</au><au>Mojarro, Irene</au><au>Garrido-Calmaestra, José L</au><au>Fernanz-Antón, Jesús</au><au>Pedregosa-Sanz, Ana</au><au>Cueva-Castro, Luisa</au><au>Echevarria-Correas, Miren A</au><au>Mallol, Montserrat</au><au>Olvera-García, María M</au><au>Navarro-Pérez, Rosalía</au><au>Fernández-Valdés-Bango, Paula</au><au>García-Fernández, Javier</au><au>Espinosa, Ángel V</au><au>Abu Khudair, Hussein</au><au>Becerra-Bolaños, Ángel</au><au>Díez-Remesal, Yolanda</au><au>Fuentes-Pradera, María A</au><au>Valbuena-Bueno, Miguel A</au><au>Quintana-Villamandos, Begoña</au><au>Llorca-García, Jordi</au><au>Fernández-López, Ignacio</au><au>Ocón-Moreno, Álvaro</au><au>Martín-Infantes, Sandra L</au><au>Valiente-Lourtau, Javier M</au><au>Amelburu-Egoscozabal, Marta</au><au>Rivera-Ramos, Hugo</au><au>Abad-Gurumeta, Alfredo</au><au>Monge-García, Manuel I</au><aucorp>HYT Study Group</aucorp><aucorp>on behalf of the HYT Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemodynamic Management guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial</atitle><jtitle>Anesthesiology (Philadelphia)</jtitle><addtitle>Anesthesiology</addtitle><date>2025-01-02</date><risdate>2025</risdate><issn>0003-3022</issn><issn>1528-1175</issn><eissn>1528-1175</eissn><abstract>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.
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.
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).
HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.
NCT05569265.</abstract><cop>United States</cop><pmid>39746186</pmid><doi>10.1097/ALN.0000000000005355</doi><orcidid>https://orcid.org/0000-0002-1958-9316</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0003-3022 |
| ispartof | Anesthesiology (Philadelphia), 2025-01 |
| issn | 0003-3022 1528-1175 1528-1175 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3151198672 |
| source | Journals@Ovid Complete |
| title | Hemodynamic Management guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial |
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