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Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients

An algorithm derived from machine learning uses the arterial waveform to predict intraoperative hypotension some minutes before episodes, possibly giving clinician’s time to intervene and prevent hypotension. Whether the Hypotension Prediction Index works well with noninvasive arterial pressure wave...

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Autores principales: Maheshwari, Kamal, Buddi, Sai, Jian, Zhongping, Settels, Jos, Shimada, Tetsuya, Cohen, Barak, Sessler, Daniel I., Hatib, Feras
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Netherlands 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889685/
https://www.ncbi.nlm.nih.gov/pubmed/31989416
http://dx.doi.org/10.1007/s10877-020-00463-5
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author Maheshwari, Kamal
Buddi, Sai
Jian, Zhongping
Settels, Jos
Shimada, Tetsuya
Cohen, Barak
Sessler, Daniel I.
Hatib, Feras
author_facet Maheshwari, Kamal
Buddi, Sai
Jian, Zhongping
Settels, Jos
Shimada, Tetsuya
Cohen, Barak
Sessler, Daniel I.
Hatib, Feras
author_sort Maheshwari, Kamal
collection PubMed
description An algorithm derived from machine learning uses the arterial waveform to predict intraoperative hypotension some minutes before episodes, possibly giving clinician’s time to intervene and prevent hypotension. Whether the Hypotension Prediction Index works well with noninvasive arterial pressure waveforms remains unknown. We therefore evaluated sensitivity, specificity, and positive predictive value of the Index based on non-invasive arterial waveform estimates. We used continuous hemodynamic data measured from ClearSight (formerly Nexfin) noninvasive finger blood pressure monitors in surgical patients. We re-evaluated data from a trial that included 320 adults ≥ 45 years old designated ASA physical status 3 or 4 who had moderate-to-high-risk non-cardiac surgery with general anesthesia. We calculated sensitivity and specificity for predicting hypotension, defined as mean arterial pressure ≤ 65 mmHg for at least 1 min, and characterized the relationship with receiver operating characteristics curves. We also evaluated the number of hypotensive events at various ranges of the Hypotension Prediction Index. And finally, we calculated the positive predictive value for hypotension episodes when the Prediction Index threshold was 85. The algorithm predicted hypotension 5 min in advance, with a sensitivity of 0.86 [95% confidence interval 0.82, 0.89] and specificity 0.86 [0.82, 0.89]. At 10 min, the sensitivity was 0.83 [0.79, 0.86] and the specificity was 0.83 [0.79, 0.86]. And at 15 min, the sensitivity was 0.75 [0.71, 0.80] and the specificity was 0.75 [0.71, 0.80]. The positive predictive value of the algorithm prediction at an Index threshold of 85 was 0.83 [0.79, 0.87]. A Hypotension Prediction Index of 80–89 provided a median of 6.0 [95% confidence interval 5.3, 6.7] minutes warning before mean arterial pressure decreased to < 65 mmHg. The Hypotension Prediction Index, which was developed and validated with invasive arterial waveforms, predicts intraoperative hypotension reasonably well from non-invasive estimates of the arterial waveform. Hypotension prediction, along with appropriate management, can potentially reduce intraoperative hypotension. Being able to use the non-invasive pressure waveform will widen the range of patients who might benefit. Clinical Trial Number: ClinicalTrials.gov NCT02872896. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10877-020-00463-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-78896852021-03-03 Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients Maheshwari, Kamal Buddi, Sai Jian, Zhongping Settels, Jos Shimada, Tetsuya Cohen, Barak Sessler, Daniel I. Hatib, Feras J Clin Monit Comput Original Research An algorithm derived from machine learning uses the arterial waveform to predict intraoperative hypotension some minutes before episodes, possibly giving clinician’s time to intervene and prevent hypotension. Whether the Hypotension Prediction Index works well with noninvasive arterial pressure waveforms remains unknown. We therefore evaluated sensitivity, specificity, and positive predictive value of the Index based on non-invasive arterial waveform estimates. We used continuous hemodynamic data measured from ClearSight (formerly Nexfin) noninvasive finger blood pressure monitors in surgical patients. We re-evaluated data from a trial that included 320 adults ≥ 45 years old designated ASA physical status 3 or 4 who had moderate-to-high-risk non-cardiac surgery with general anesthesia. We calculated sensitivity and specificity for predicting hypotension, defined as mean arterial pressure ≤ 65 mmHg for at least 1 min, and characterized the relationship with receiver operating characteristics curves. We also evaluated the number of hypotensive events at various ranges of the Hypotension Prediction Index. And finally, we calculated the positive predictive value for hypotension episodes when the Prediction Index threshold was 85. The algorithm predicted hypotension 5 min in advance, with a sensitivity of 0.86 [95% confidence interval 0.82, 0.89] and specificity 0.86 [0.82, 0.89]. At 10 min, the sensitivity was 0.83 [0.79, 0.86] and the specificity was 0.83 [0.79, 0.86]. And at 15 min, the sensitivity was 0.75 [0.71, 0.80] and the specificity was 0.75 [0.71, 0.80]. The positive predictive value of the algorithm prediction at an Index threshold of 85 was 0.83 [0.79, 0.87]. A Hypotension Prediction Index of 80–89 provided a median of 6.0 [95% confidence interval 5.3, 6.7] minutes warning before mean arterial pressure decreased to < 65 mmHg. The Hypotension Prediction Index, which was developed and validated with invasive arterial waveforms, predicts intraoperative hypotension reasonably well from non-invasive estimates of the arterial waveform. Hypotension prediction, along with appropriate management, can potentially reduce intraoperative hypotension. Being able to use the non-invasive pressure waveform will widen the range of patients who might benefit. Clinical Trial Number: ClinicalTrials.gov NCT02872896. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10877-020-00463-5) contains supplementary material, which is available to authorized users. Springer Netherlands 2020-01-27 2021 /pmc/articles/PMC7889685/ /pubmed/31989416 http://dx.doi.org/10.1007/s10877-020-00463-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Maheshwari, Kamal
Buddi, Sai
Jian, Zhongping
Settels, Jos
Shimada, Tetsuya
Cohen, Barak
Sessler, Daniel I.
Hatib, Feras
Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients
title Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients
title_full Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients
title_fullStr Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients
title_full_unstemmed Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients
title_short Performance of the Hypotension Prediction Index with non-invasive arterial pressure waveforms in non-cardiac surgical patients
title_sort performance of the hypotension prediction index with non-invasive arterial pressure waveforms in non-cardiac surgical patients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889685/
https://www.ncbi.nlm.nih.gov/pubmed/31989416
http://dx.doi.org/10.1007/s10877-020-00463-5
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