The Hypotension Prediction Index (HPI) is a validated algorithm developed by applying machine learning for predicting intraoperative arterial hypotension (IOH). We evaluated whether the HPI, combined with a personalized treatment protocol, helps to reduce IOH (depth and duration) and perioperative events in real practice. This was a single-center retrospective study including 104 consecutive adults undergoing urgent or elective non-cardiac surgery with moderate-to-high risk of bleeding, requiring invasive blood pressure and continuous cardiac output monitoring. Depending on the sensor, two comparable groups were identified: patients managed following the institutional protocol of personalized goal-directed fluid therapy (GDFT, n = 52), or this GDFT supported by the HPI (HPI, n = 52). The time-weighted average of hypotension for a mean arterial pressure < 65 mmHg (TWA_MAP<65), postoperative complications and length of hospital stay (LOS) were automatically downloaded from medical records and revised by clinicians blinded to the management received by patients. Differences in preoperative variables (i.e. physical status -ASA class-, acute kidney Injury-AKI- risk) and outcomes were analyzed using non-parametric tests with Hodges-Lehmann estimator for the median of differences. ASA class and AKI risk were similar (p = 0.749 and p = 0.837, respectively). Blood loss was also comparable (p = 0.279). HPI patients had a lower TWA_MAP<65 [0.09 mmHg (0–0.48 mmHg)] vs [0.23 mmHg (0.01 to 0.97 mmHg)], p = 0.037. Postoperative complications were less prevalent in the HPI patients (0.46 ± 0.98 vs. 0.88 ± 1.20), p = 0.035. Finally, LOS was significantly shorter among HPI patients with a median difference of 2 days (p = 0.019). The HPI combined with a GDFT protocol may help to minimize the severity of IOH during non-cardiac surgery.

低血压预测指数 (HPI) 是一种经过验证的算法，通过应用机器学习来预测术中动脉低血压 (IOH)。我们评估了 HPI 与个性化治疗方案相结合是否有助于在实际实践中减少 IOH（深度和持续时间）和围手术期事件。这是一项单中心回顾性研究，包括 104 名连续接受紧急或择期非心脏手术的成年人，这些手术具有中度至高度出血风险，需要有创血压和连续心输出量监测。根据传感器的不同，确定了两个可比较的组：按照个性化目标导向液体治疗的机构方案管理的患者（GDFT，n = 52），或由 HPI 支持的 GDFT（HPI，n = 52）。_MAP<65 )、术后并发症和住院时间 (LOS) 从医疗记录中自动下载，并由对患者接受的管理不知情的临床医生进行修改。术前变量（即身体状况-ASA 等级-、急性肾损伤-AKI- 风险）和结果的差异使用 Hodges-Lehmann 估计量的非参数检验分析差异中值。ASA 等级和 AKI 风险相似（分别为 p = 0.749 和 p = 0.837）。失血量也相当 (p = 0.279)。HPI 患者具有较低的 TWA _MAP<65[0.09 毫米汞柱（0–0.48 毫米汞柱）] 对比 [0.23 毫米汞柱（0.01 至 0.97 毫米汞柱）]，p = 0.037。HPI 患者的术后并发症发生率较低（0.46 ± 0.98 对 0.88 ± 1.20），p = 0.035。最后，HPI 患者的 LOS 显着缩短，中位差异为 2 天 (p = 0.019)。HPI 与 GDFT 协议相结合可能有助于在非心脏手术期间最大限度地减少 IOH 的严重程度。