Identificador persistente para citar o vincular este elemento: http://hdl.handle.net/10553/136798
Título: Hemodynamic Management Guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial
Autores/as: Ripollés-Melchor, Javier
Tomé-Roca, José L.
Zorrilla-Vaca, Andrés
Aldecoa, César
Colomina, María J.
Bassas-Parga, Eva
Lorente, Juan V.
Ruiz-Escobar, Alicia
Carrasco-Sánchez, Laura
Sadurni-Sarda, Marc
Rivas, Eva
Puig, Jaume
Agudelo-Montoya, Elizabeth
Del Rio-Fernández, Sabela
García-López, Daniel
Adell-Pérez, Ana B.
Guillen, Antonio
Venturoli-Ojeda, Rocío
Fernández-Torres, Bartolomé
Abad-Motos, Ane
Mojarro, Irene
Garrido-Calmaestra, José L.
Fernanz-Antón, Jesús
Pedregosa-Sanz, Ana
Cueva-Castro, Luisa
Echevarria-Correas, Miren A.
Mallol, Montserrat
Olvera-García, María M.
Navarro-Pérez, Rosalía
Fernández-Valdés-Bango, Paula
García-Fernández, Javier
Espinosa, Ángel V.
Abu Khudair, Hussein
Becerra Bolaños, Ángel 
Díez-Remesal, Yolanda
Fuentes-Pradera, María A.
Valbuena-Bueno, Miguel A.
Quintana-Villamandos, Begoña
Llorca-García, Jordi
Fernández-López, Ignacio
Ocón-Moreno, Álvaro
Martín-Infantes, Sandra L.
Valiente-Lourtau, Javier M.
Amelburu-Egoscozabal, Marta
Rivera-Ramos, Hugo
Abad-Gurumeta, Alfredo
Monge-García, Manuel I.
Rodríguez Pérez, Aurelio Eduardo 
Clasificación UNESCO: 32 Ciencias médicas
321303 Anestesiología
Fecha de publicación: 2025
Publicación seriada: Anesthesiology (Philadelphia) 
Resumen: Background: Postoperative acute kidney injury (AKI) after major abdominal surgery leads to poor outcomes. The Hypotension Prediction Index (HPI; Edwards Lifesciences, USA) may aid in managing intraoperative hemodynamic instability. This study assessed whether 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. A total of 917 patients (65 yr or older or older than 18 yr with American Society of Anesthesiologists Physical Status greater than 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 yr (interquartile range, 65 to 77) in the HPI group and 70 yr (interquartile range, 63 to 76) in standard care group. American Society of Anesthesiologists Physical Status III/IV was 58.3% (268 of 459) in the HPI group and 57.9% (263 of 458) in standard care group. The incidence of moderate-to-severe AKI was 6.1% (28 of 459) in the HPI group and 7.0% (32 of 458) in the standard care group (risk ratio, 0.89; 95% CI, 0.54 to 1.49; P = 0.66). Overall complications occurred in 31.9% (146 of 459) of the HPI group and 29.7% (136 of 458) of the standard care group (risk ratio, 1.08; 95% CI, 0.85 to 1.37; P = 0.52). The incidence of renal replacement therapy did not differ between groups. Median length of hospital stay was 6 days (interquartile range, 4 to 10) in both groups. The 30-day mortality was 1.1% (5 of 459) in the HPI group versus 0.9% (4 of 458) in standard care group (risk ratio, 1.35; 95% CI, 0.36 to 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.
URI: http://hdl.handle.net/10553/136798
ISSN: 0003-3022
DOI: 10.1097/ALN.0000000000005355
Fuente: Anesthesiology [eISSN 0003-3022], v. 142(4), pp. 639-654 (Abril 2025)
Colección:Artículos
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