Ability of an arterial waveform analysis-derived hypotension prediction index to predict future hypotensive events in surgical patients

Davies, Simon James; Vistisen, Simon Tilma; Jian, Zhongping; Hatib, Feras; Scheeren, Thomas W. L.

doi:10.1213/ane.0000000000004121

Cited by 219Hemodynamic Monitoring and TherapyHealthcare Technology and Patient MonitoringCardiac, Anesthesia and Surgical Outcomes

Ability of an arterial waveform analysis-derived hypotension prediction index to predict future hypotensive events in surgical patients

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Davies, Simon James, Vistisen, Simon Tilma, Jian, Zhongping, Hatib, Feras, Scheeren, Thomas W. L.·2020·Anesthesia & Analgesia

DOI 10.1213/ane.0000000000004121

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Abstract

BACKGROUND: Intraoperative hypotension is associated with worse perioperative outcomes for patients undergoing major noncardiac surgery. The Hypotension Prediction Index is a unitless number that is derived from an arterial pressure waveform trace, and as the number increases, the risk of hypotension occurring in the near future increases. We investigated the diagnostic ability of the Hypotension Prediction Index in predicting impending intraoperative hypotension in comparison to other commonly collected perioperative hemodynamic variables. METHODS: This is a 2-center retrospective analysis of patients undergoing major surgery. Data were downloaded and analyzed from the Edwards Lifesciences EV1000 platform. Receiver operating characteristic curves were constructed for the Hypotension Prediction Index and other hemodynamic variables as well as event rates and time to event. RESULTS: Two hundred fifty-five patients undergoing major surgery were included in the analysis yielding 292,025 data points. The Hypotension Prediction Index predicted hypotension with a sensitivity and specificity of 85.8% (95% CI, 85.8%–85.9%) and 85.8% (95% CI, 85.8%–85.9%) 5 minutes before a hypotensive event (area under the curve, 0.926 [95% CI, 0.925–0.926]); 81.7% (95% CI, 81.6%–81.8%) and 81.7% (95% CI, 81.6%–81.8%) 10 minutes before a hypotensive event (area under the curve, 0.895 [95% CI, 0.894–0.895]); and 80.6% (95% CI, 80.5%–80.7%) and 80.6% (95% CI, 80.5%–80.7%) 15 minutes before a hypotensive event (area under the curve, 0.879 [95% CI, 0.879–0.880]). The Hypotension Prediction Index performed superior to all other measured hemodynamic variables including mean arterial pressure and change in mean arterial pressure over a 3-minute window. CONCLUSIONS: The Hypotension Prediction Index provides an accurate real time and continuous prediction of impending intraoperative hypotension before its occurrence and has superior predictive ability than the commonly measured perioperative hemodynamic variables.

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Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients
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This Month in Anesthesiology
(2024) · Anesthesiology · doi:10.1097/aln.0000000000005160
Hypotension Prediction Index Is Equally Effective in Predicting Intraoperative Hypotension during Noncardiac Surgery Compared to a Mean Arterial Pressure Threshold: A Prospective Observational Study
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Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension
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Applicability of hypotension prediction index to surgical patients
Lee, K., & Jung, K. T. (2022) · Medical Biological Science and Engineering · doi:10.30579/mbse.2022.5.2.57

Authors: Davies, S. J., Vistisen, S. T., Jian, Z., Hatib, F., & Scheeren, T. W. L.
Affiliations: National Health Service (GB)
Aarhus University (DK)
Edwards Lifesciences (United States) (US)
University Medical Center Groningen (NL)
Corresponding author: Davies, Simon James
ORCID: Davies, Simon James
Vistisen, Simon Tilma
Hatib, Feras
Scheeren, Thomas W. L.
Venue: Anesthesia & Analgesia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2020-02
Volume: 130
Issue: 2
Pages: 352-359
ISSN: 0003-2999 (ISSN-L)
DOI: 10.1213/ane.0000000000004121
OpenAlex: W2928352011
Cited by: 219
References: 23
Citations by year: 2026: 26 · 2025: 29 · 2024: 42 · 2023: 33 · 2022: 28 · 2021: 30 · 2020: 24 · 2019: 7
FWCI: 21.44
Type: journal article
Language: en
Update notices: correction (2023-09-01)
Open access: green
hdl.handle.net
Licence: other-oa
Locations: Anesthesia & Analgesia (publishedVersion)
PubMed (publishedVersion)
Scopus (Elsevier) (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Funders: Edwards Lifesciences
Topics: Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords: Hypotension Prediction Index, intraoperative hypotension, arterial waveform analysis, non-cardiac surgery, hemodynamic monitoring, hypotension prediction, mean arterial pressure, perioperative outcomes, sensitivity and specificity, time-to-event prediction
MeSH terms: Aged, Aged, 80 and over, Female, Forecasting, Humans, Hypotension, Intraoperative Complications, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Retrospective Studies, Monitoring, Intraoperative, Arterial Pressure

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Ability of an arterial waveform analysis-derived hypotension prediction index to predict future hypotensive events in surgical patients

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