Evidence map›Paper›PMID 38439069›Full record

ArticlePerioperative medicine (London, England)2024

AcumenTM hypotension prediction index guidance for prevention and treatment of hypotension in noncardiac surgery: a prospective, single-arm, multicenter trial.

Xiaodong Bao, Sathish S Kumar, Nirav J Shah, Donald Penning, Mitchell Weinstein, Gaurav Malhotra, Sydney Rose, David Drover, Matthew W Pennington, Karen Domino and 7 more

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Perioperative medicine (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03805217 (Prospective, Single-Arm, Open-Label, Multicenter Study of Hypotension Prevention and Treatment in Patients Receiving Arterial Pressure Monitoring with Acumen™ Hypotension Prediction Index Feature Software), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
2.3field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03805217 completednot on this map

Prospective, Single-Arm, Open-Label, Multicenter Study of Hypotension Prevention and Treatment in Patients Receiving Arterial Pressure Monitoring with Acumen™ Hypotension Prediction Index Feature Software

TypeobservationalSponsorEdwards LifesciencesRan2019 to 2020Enrolled485ConditionsHypotensionArmsEV1000A Clinical Platform with Acumen Hypotension Prediction Index Feature Software
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 12 institutions in 1 country.

Xiaodong BaoAnesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA. xbao1@mgh.harvard.edu.
Sathish S KumarDepartment of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
Nirav J ShahDepartment of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
Donald PenningDepartment of Anesthesiology, Henry Ford Health System, Detroit, MI, USA.
Mitchell WeinsteinDepartment of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Gaurav MalhotraDepartment of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Sydney RoseDepartment of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.
David DroverDepartment of Anesthesia, Stanford University, Stanford, CA, USA.
Matthew W PenningtonDepartment of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Karen DominoDepartment of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Lingzhong MengDepartment of Anesthesiology, Indiana University School of Medicine, Indianapolis, IN, USA.
Mariam TreggiariDepartment of Anesthesiology, Duke University School of Medicine, Durham, NC, USA.
Claudia ClavijoDepartment of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Gebhard WagenerDepartment of Anesthesiology, College of Physicians & Surgeons of Columbia University, New York, NY, USA.
Hovig ChitilianAnesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Kamal MaheshwariDepartment of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA.
HPI Study Team
Hospital of the University of Pennsylvania · USMassachusetts General Hospital · USUniversity of Michigan · USUniversity of Washington · USCleveland Clinic · USColumbia University · USDuke University · USHenry Ford Health System · USIndiana University School of MedicineOregon Health & Science University · USStanford University · USUniversity of Colorado Anschutz Medical Campus · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntraoperative hypotension is common during noncardiac surgery and is associated with postoperative myocardial infarction, acute kidney injury, stroke, and severe infection. The Hypotension Prediction Index software is an algorithm based on arterial waveform analysis that alerts clinicians of the patient's likelihood of experiencing a future hypotensive event, defined as mean arterial pressure < 65 mmHg for at least 1 min.

methodsTwo analyses included (1) a prospective, single-arm trial, with continuous blood pressure measurements from study monitors, compared to a historical comparison cohort. (2) A post hoc analysis of a subset of trial participants versus a propensity score-weighted contemporaneous comparison group, using external data from the Multicenter Perioperative Outcomes Group (MPOG). The trial included 485 subjects in 11 sites; 406 were in the final effectiveness analysis. The post hoc analysis included 457 trial participants and 15,796 comparison patients. Patients were eligible if aged 18 years or older, American Society of Anesthesiologists (ASA) physical status 3 or 4, and scheduled for moderate- to high-risk noncardiac surgery expected to last at least 3 h. MEASUREMENTS: minutes of mean arterial pressure (MAP) below 65 mmHg and area under MAP < 65 mmHg.

resultsAnalysis 1: Trial subjects (n = 406) experienced a mean of 9 ± 13 min of MAP below 65 mmHg, compared with the MPOG historical control mean of 25 ± 41 min, a 65% reduction (p < 0.001). Subjects with at least one episode of hypotension (n = 293) had a mean of 12 ± 14 min of MAP below 65 mmHg compared with the MPOG historical control mean of 28 ± 43 min, a 58% reduction (p< 0.001). Analysis 2: In the post hoc inverse probability treatment weighting model, patients in the trial demonstrated a 35% reduction in minutes of hypotension compared to a contemporaneous comparison group [exponentiated coefficient: - 0.35 (95%CI - 0.43, - 0.27); p < 0.001].

conclusionsThe use of prediction software for blood pressure management was associated with a clinically meaningful reduction in the duration of intraoperative hypotension. Further studies must investigate whether predictive algorithms to prevent hypotension can reduce adverse outcomes.

trial registrationClinical trial number: NCT03805217. Registry URL: https://clinicaltrials.gov/ct2/show/NCT03805217 . Principal investigator: Xiaodong Bao, MD, PhD. Date of registration: January 15, 2019.

Indexed as

Blood pressure monitorClinical decision supportHypotensionHypotension Prediction Index

Identifiers

PMID38439069
PMCPMC10913612
OpenAlexW4392380106

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.