Discussion
blood loss, hypotension, AUT, hypotensive, Hypotension
BLOOD LOSS, EVENTS, HYPOTENSIVE EPISODE, HYPOTENSIVE
In the studied cohort, use of machine learning algorithm guided hemodynamic optimization (HPI) significantly reduced the number and duration of intraoperative hypotensive episodes, as well as AUT and the primary outcome—TWA of AUT.These results are in agreement with results obtained by Wijnberge et al. [A recent study by Enevoldsen et al. [Our results show that while incidence and duration of hypotension were significantly reduced in patients that used HPI algorithm, there were no significant differences in clinical outcomes, however these results should be interpreted with caution due to sample size and inadequate statistical power. Results of a large retrospective study by Gregory et al. [There was one patient in the While hemodynamic stability was much better preserved in the Hypotension prediction index has proven to be reliable enough in prediction of intraoperative hypotensive events even when used with non-invasive volume clamp method, with similar sensitivity and specificity levels as when used with arterial lines [Since most elective thoracic procedures (lung and esophagus resection) are generally not associated with major blood loss and fluid shift, most hemodynamic changes are due to surgical manipulation, the patient’s position and changes in cardiac output during OLV, which rises after pleural opening [One probable reason why both incidence and duration of hypotensive events were significantly lower in the Further extension of machine learning algorithms in order to preserve intraoperative hemodynamic stability is application of closed loop systems that automatically administer fluids and vasopressors according to measured hemodynamic variables, which have reduced duration of intraoperative hypotension (< 65 mmHg) by 21.1%, as well as a reduction of intraoperative fluid balance (+ 1600 vs + 2050 ml) and lower serum lactate levels (1.2 vs 2.7 mmol/L) in patients undergoing moderate to high-risk surgery as demonstrated by Joosten et al. [It must be noted that most patients in both groups were graded as ASA 3, and although significant comorbidities are present (most of which are associated with smoking), careful multidisciplinary approach and preoperative assessment of cardiac and lung reserve are essential in decreasing the duration of mechanical ventilation, ICU and hospital stay, and improving patient outcomes in general [