Intraoperative Implementation of the Hypotension Probability Indicator

HYPE Trial. Intraoperative Implementation of the Hypotension Probability Indicator (HPI) Algorithm: a Pilot Randomized Controlled Clinical Trial

Reducing intraoperative hypotension using FlotracIQ with HPI software.

Intraoperative hypotension occurs often. Even short durations of hypotension are suggested to be associated with increased risk for renal insufficiency and myocardial ischemia. Currently treatment of these hypotensive episodes is not proactive. Edwards Lifesciences has developed an algorithm using continuous invasively-measured arterial waveforms to predict hypotension with high accuracy minutes before blood pressure actually decreases. Hypothesis: the use of this algorithm will alter treatment of hypotension and reduces the incidence of hypotension.

Inclusion Criteria:

• Aged 18 years or older
• Planned for elective non-cardiac non-day surgery with an expected duration of more than 2 hours
• Planned to receive general anaesthesia
• Planned to receive an arterial line during surgery
• Aim for MAP of 65 mmHg during surgery
• Being able to give written informed consent prior to surgery

Exclusion Criteria:

• Aim for MAP other than 65 mmHg at discretion treating physician
• Significant hypotension before surgery defined as a MAP <65
• Right- or left sided cardiac failure (e.g. LVEF<35%)
• Known cardiac shunts (significant)
• Known aortic stenosis (severe)
• Severe cardiac arrhythmias including atrial fibrillation
• Requiring dialysis
• Liver surgery
• Vascular surgery with clamping of the aorta
• Perioperative Goal Directed Therapy (PGDT) protocol