Brusasco Claudia, Micali Marco, Cucciolini Giada, Filolli Desjan, Gandini Michela, Lattuada Marco, Introini Carlo, Corradi Francesco
Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy.
Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy.
J Clin Med. 2025 Sep 5;14(17):6285. doi: 10.3390/jcm14176285.
Hypotensive events may occur during surgical interventions and are associated with major postoperative complications, depending on their duration and severity. Intraoperative hemodynamic goal-directed therapy can reduce postoperative complications and mortality in high-risk surgeries and high-risk patients. The study hypothesis was that a proactive approach by hypotension predictive index (HPI) is more effective than a reactive goal-directed therapy (GDT) in reducing the number of hypotensive events during radical cystectomy and that this is associated with improved postoperative outcomes. The study was a single-center prospective observational study conducted at Galliera Hospital, from November 2019 to February 2025, with a before-after population of sixty-seven patients with reactive approach (GDT group) and sixty-five patients with a proactive approach (HPI group) undergoing radical cystectomy, managed with a standardized ERAS protocol and invasive or non-invasive hemodynamic monitoring. The aim of the study was to compare the incidence, duration, and severity of intraoperative hypotensive episodes between a proactive approach guided by the Hypotension Prediction Index (HPI) and a reactive goal-directed therapy (GDT) strategy guided by an advanced hemodynamic monitoring system. The HPI group had a 65% reduction in hypotensive events (225 vs. 633, < 0.001), with a 72% reduction in their duration (14 vs. 49 min, < 0.001) and an 85% reduction in their severity (time-weighted average MAP < 65 mmHg 0.11 vs. 0.76, < 0.001) compared to the GDT group. The HPI-guided group showed a reduction in postoperative infectious complications (10 vs. 26) and in-hospital length of stay (8 ± 4 versus 13 ± 8 days). A proactive approach may allow attenuating the occurrence and severity of hypotensive events more than a reactive goal-directed approach during radical cystectomy.
手术干预期间可能会发生低血压事件，根据其持续时间和严重程度，这些事件与主要术后并发症相关。术中血流动力学目标导向治疗可降低高危手术和高危患者的术后并发症及死亡率。本研究的假设是，在根治性膀胱切除术中，通过低血压预测指数（HPI）采取的主动方法比反应性目标导向治疗（GDT）在减少低血压事件数量方面更有效，且这与改善术后结局相关。该研究是一项在加列拉医院进行的单中心前瞻性观察性研究，时间从2019年11月至2025年2月，共有67例采用反应性方法的患者（GDT组）和65例采用主动方法的患者（HPI组）接受根治性膀胱切除术，采用标准化的加速康复外科方案以及有创或无创血流动力学监测。本研究的目的是比较在低血压预测指数（HPI）引导下的主动方法与先进血流动力学监测系统引导下的反应性目标导向治疗（GDT）策略之间术中低血压发作的发生率、持续时间和严重程度。与GDT组相比，HPI组的低血压事件减少了65%（225次对633次，<0.001），持续时间减少了72%（14分钟对49分钟，<0.001），严重程度降低了85%（时间加权平均MAP<65 mmHg，0.11对0.76，<0.001）。HPI引导组的术后感染并发症（10例对26例）和住院时间（8±4天对13±8天）有所减少。在根治性膀胱切除术中，主动方法可能比反应性目标导向方法更能减轻低血压事件的发生和严重程度。
