NCT06631482

Comparison Bewteen Intraoperative HPI vs. High Mean Arterial Pressure Threshold

Randomized Controlled Trial Comparing HPI and Elevated Threshold Monitor Alarms in Preventing Intraoperative Hypotension

• Status: Active Not Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 100 (estimated)
• Sponsor: National Taiwan University Hospital · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

Intraoperative hypotension (IOH) is a common and serious complication during surgery, closely associated with poor postoperative outcomes. Traditionally, anesthesiologists rely on real-time physiological parameters and alarms to monitor blood pressure, but the low alarm thresholds may lead to delayed interventions. The Hypotension Prediction Index (HPI) is a novel predictive tool that uses arterial waveform signals and advanced algorithms to forecast hypotensive events in advance. Recent observational studies have shown that HPI's accuracy in predicting hypotension is highly consistent with setting the physiological monitor's alarm threshold to 73 mmHg. This study will compare the effectiveness of HPI and a raised alarm threshold of 73 mmHg in preventing IOH. While HPI is promising with its AI-assisted approach to patient care, its high cost due to the advanced technology raises concerns. If its accuracy is comparable to simply raising the traditional monitor threshold, it may not lead to substantial changes in clinical practice.

Detailed description

Intraoperative hypotension (IOH) is a significant complication that affects surgical patients, potentially leading to adverse outcomes postoperatively. Standard practices involve relying on monitoring devices with low alarm thresholds for blood pressure, which may result in delayed interventions. The Hypotension Prediction Index (HPI) offers a predictive approach by analyzing arterial waveform signals and using complex algorithms to detect potential hypotensive episodes early. Recent observational studies have suggested that HPI's accuracy in predicting hypotension aligns closely with raising the physiological monitor alarm threshold to 73 mmHg. To further investigate this, this study will compare the effects of setting a traditional monitor alarm threshold at 73 mmHg with using HPI to prevent IOH. In this study, patients will be randomly assigned to two groups. In the HPI group, interventions will be initiated when the HPI value exceeds 85. These interventions will follow a protocol that includes fluid administration, norepinephrine, and dobutamine to prevent hypotension. The control group will have their alarm threshold set at 73 mmHg. For these patients, interventions will be based on stroke volume variation (SVV) and clinical judgment, utilizing fluid and norepinephrine as needed. HPI is an attractive AI-based tool for medical care, but its high cost due to advanced technology raises questions. If its accuracy proves to be similar to simply raising the alarm threshold to 73 mmHg, it may not lead to meaningful changes in clinical practice. The study aims to compare the efficacy of these two methods in reducing the incidence of IOH.

Conditions

• Hypotension During Surgery

Interventions

Type	Name	Description
DEVICE	Maintain HPI < 85	Protocolized treatment with fluid administration, norepinephrine, and dobutamine to prevent intraoperative hypotension. The two arms are triggered by different alarms: one from a traditional monitor with an elevated MAP threshold of 73 mmHg, and the other from an HPI threshold of 85.
DRUG	Maintain MAP>=73	Protocolized treatment with fluid administration, norepinephrine, and dobutamine to prevent intraoperative hypotension. The two arms are triggered by different alarms: one from a traditional monitor with an elevated MAP threshold of 73 mmHg, and the other from an HPI threshold of 85.

Timeline

• Start date: 2024-09-16
• Primary completion: 2025-10-14
• Completion: 2026-05-31
• First posted: 2024-10-08
• Last updated: 2025-12-17

Locations

2 sites across 1 country: Taiwan

Regulatory

• FDA-regulated device study