From the Department of Anaesthesia, Critical Care and Perioperative Medicine, York Teaching Hospital National Health Service Foundation Trust, York, United Kingdom.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Anesth Analg. 2020 Feb;130(2):352-359. doi: 10.1213/ANE.0000000000004121.
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.
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.
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.
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.
术中低血压与接受非心脏大手术的患者围手术期结局恶化有关。低血压预测指数是一个无单位的数值，源自动脉压力波形迹线，随着数值的增加，近期发生低血压的风险增加。我们研究了低血压预测指数在预测即将发生的术中低血压方面与其他常用围手术期血流动力学变量相比的诊断能力。
这是一项对接受大手术的患者进行的 2 中心回顾性分析。数据从 Edwards Lifesciences EV1000 平台下载并进行分析。为低血压预测指数和其他血流动力学变量以及事件发生率和事件时间构建了接收者操作特征曲线。
255 名接受大手术的患者被纳入分析，共产生 292025 个数据点。低血压预测指数预测低血压的敏感性和特异性分别为 85.8%（95%置信区间，85.8%-85.9%）和 85.8%（95%置信区间，85.8%-85.9%），在发生低血压事件前 5 分钟（曲线下面积，0.926[95%置信区间，0.925-0.926]）；在发生低血压事件前 10 分钟，分别为 81.7%（95%置信区间，81.6%-81.8%）和 81.7%（95%置信区间，81.6%-81.8%）（曲线下面积，0.895[95%置信区间，0.894-0.895]）；在发生低血压事件前 15 分钟，分别为 80.6%（95%置信区间，80.5%-80.7%）和 80.6%（95%置信区间，80.5%-80.7%）（曲线下面积，0.879[95%置信区间，0.879-0.880]）。低血压预测指数的表现优于所有其他测量的围手术期血流动力学变量，包括平均动脉压和 3 分钟窗口内平均动脉压的变化。
低血压预测指数可在低血压发生前实时、连续地准确预测即将发生的术中低血压，其预测能力优于常用的围手术期血流动力学变量。
