Portal de Periódicos da CAPES

Hemodynamic Management guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial

2025; Lippincott Williams & Wilkins; Linguagem: Inglês

10.1097/aln.0000000000005355

1528-1175

Javier Ripollés‐Melchor, J.L. Tomé-Roca, Andrés Zorrilla‐Vaca, César Aldecoa, M.J. Colomina, Eva Bassas-Parga, J.V. Lorente, Alicia Ruiz-Escobar, Laura Carrasco-Sánchez, Marc Sadurni-Sarda, Eva Rivas, Jaume Puig, Elizabeth Agudelo-Montoya, Sabela del- Río-Fernández, Daniel García-López, Ana B. Adell-Pérez, Antonio Guillén, Rocío Venturoli-Ojeda, Bartolomé Fernández Torres, Ane Abad-Motos, Irene Mojarro, José L. Garrido-Calmaestra, Jesús Fernanz-Antón, Ana Pedregosa-Sanz, Luisa F. Cueva-Castro, Miren A. Echevarria-Correas, Montserrat Mallol, María M. Olvera-García, R. Navarro-Pérez, Paula Fernández-Valdés-Bango, F. Fernandez, Ángel Espinosa, Hussein Abu Khudair, Ángel Ignacio Lledó Becerra, Yolanda Díez-Remesal, María A. Fuentes‐Pradera, Miguel A. Valbuena-Bueno, Begoña Quintana-Villamandos, Jordi Llorca-García, Ignacio Fernández-López, Álvaro Ocón-Moreno, Sandra L. Martín-Infantes, Javier M. Valiente-Lourtau, Marta Amelburu-Egoscozabal, Hugo Rivera-Ramos, A. Abad‐Gurumeta, Manuel Ignacio Monge García,

Cardiac, Anesthesia and Surgical Outcomes

Background: Postoperative acute kidney injury (AKI) after major abdominal surgery leads to poor outcomes. The Hypotension Prediction Index (HPI) may aid in managing intraoperative hemodynamic instability. This study assessed if HPI-guided therapy reduces moderate-to-severe AKI incidence in moderate-to-high-risk elective abdominal surgery patients. Methods: This multicenter randomized trial was conducted from October 2022 to February 2024 across 28 hospitals evaluating HPI-guided management compared to a wide range of real-world hemodynamic approaches. 917 patients (≥65 years or >18 years with ASA status >II) undergoing moderate-to-high-risk elective abdominal surgery were included in the intention-to-treat analysis. HPI-guided management triggered interventions when the HPI exceeded 80, using fluids and/or vasopressors/inotropes based on hemodynamic data. The primary outcome was the incidence of moderate-to-severe AKI within the first 7 days after surgery. Secondary outcomes included overall complications, the need for renal replacement therapy, duration of hospital stay, and 30-day mortality. Results: Median age was 71 years (IQR, 65-77) in the HPI group and 70 years (IQR, 63-76) in standard care group. ASA status III/IV was 58.3% (268/459) in the HPI group and 57.9% (263/458) in standard care group. The incidence of moderate-to-severe AKI was 6.1% (28/459) in the HPI group and 7.0% (32/458) in the standard care group (RR 0.89, 95% 0.54-1.49; P =0.66). Overall complications occurred in 31.9% (146/459) of the HPI group and 29.7% (136/458) of the standard care group (RR 1.08, 95% CI 0.85-1.37; P = 0.52). The incidence of renal replacement therapy did not differ between groups. Median length of hospital stay was 6 days (IQR, 4-10) in both groups. The 30-day mortality was 1.1% (5/459) in the HPI group versus 0.9% (4/458) in standard care group (RR 1.35, 95% CI 0.36-5.10; P = 0.66). Conclusions: HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care. ClinicalTrials.gov Identifier: NCT05569265