Introduction
cerebral and myocardial infarction, myocardial infarction, IOH includes systolic blood pressure, hypovolemia, cerebrovascular insult, IOH, hypotension, postoperative organ dysfunction, Hypotension, acute kidney injury
MYOCARDIAL INFARCTION, POSTOPERATIVE COMPLICATIONS, ADVERSE EVENTS, HEMODYNAMIC INSTABILITY, COMPLICATIONS, EDWARDS
In Europe, approximately 20 million major surgical procedures are performed annually. Up to 5% of these patients will die and 10–15% will develop adverse events that could have been prevented in more than 33% of cases [Intraoperative hypotension (IOH) may increase mortality and morbidity rates in the postoperative period, and is associated with adverse events such as acute kidney injury, cerebral and myocardial infarction [A recent randomized controlled trial reported that preventing intraoperative hypotension reduces the risk of postoperative organ dysfunction by about a quarter [Absolute threshold in defining IOH includes systolic blood pressure (SBP) less than 90 mmHg or mean arterial pressure (MAP) less than 65 mmHg, while a 20% reduction in baseline SBP or a 30% reduction in MAP represents the relative threshold. Most patients in noncardiac surgery experience at least one episode during which MAP decreases to < 65 mmHg, and known causes are anesthetic drugs, uncorrected hypovolemia, preexisting comorbidities, and surgical manipulation [The “Hypotension Prediction Index” (HPI) is a novel hemodynamic monitoring tool that predicts episodes of intraoperative hypotension before they occur. It has recently been shown that applying Acumen (Edwards Lifesciences, Irvine, Ca, USA) HPI software algorithm on data obtained by invasive blood pressure monitoring sensor during noncardiac surgery enables earlier assessment of causes of impending hypotension and timely response to possible hemodynamic instability [Given the significant association between hypotension and postoperative complications and adverse outcomes such as increased incidence of myocardial infarction and cerebrovascular insult, as well as increased hospital stay [The aim of this study was to examine whether use of machine-learning algorithm guided intraoperative patient hemodynamic optimization reduces duration and severity of hypotension and its complications during and after thoracic surgery compared to conventional pulse contour analysis goal-directed hemodynamic optimization.