Effect of a Machine Learning-Derived Early Warning Tool With Treatment Protocol on Hypotension During Cardiac Surgery and ICU Stay: The Hypotension Prediction 2 (HYPE-2) Randomized Clinical Trial
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Le résumé fourni par la source
OBJECTIVES: Cardiac surgery is associated with perioperative complications, some of which might be attributable to hypotension. The Hypotension Prediction Index (HPI), a machine-learning-derived early warning tool for hypotension, has only been evaluated in noncardiac surgery. We investigated whether using HPI with diagnostic guidance reduced hypotension during cardiac surgery and in the ICU. DESIGN: Randomized clinical trial conducted between May 2021 and February 2023. SETTING: Single-center study conducted in an academic hospital in the Netherlands. PATIENTS: Adults undergoing elective on-pump coronary artery bypass grafting, with or without single heart valve surgery, were enrolled if a mean arterial pressure (MAP) greater than or equal to 65 mm Hg was targeted during the surgical off-pump phases and ICU stay. After eligibility assessment, 142 of 162 patients approached gave informed consent for participation. INTERVENTIONS: Patients randomized 1:1 received either diagnostic guidance in addition to standard care if HPI reached greater than or equal to 75 ( n = 72) or standard care alone ( n = 70). MEASUREMENTS AND MAIN RESULTS: The primary outcome was the severity of hypotension, measured as time-weighted average (TWA) of MAP less than 65 mm Hg. Secondary outcomes encompassed hypertension severity and intervention disparities. Of 142 patients randomized, 130 were included in the primary analysis. The HPI group showed 63% reduction in median TWA of hypotension compared with the standard care group, with a median of differences of -0.40 mm Hg (95% CI, -0.65 to -0.27; p < 0.001). In the HPI group, patients spent a median 28 minutes (95% CI, 17-44 min) less in hypotension, with a measurement duration of 322 minutes in the HPI group and 333 minutes in the standard care group. No significant differences were observed in hypertension severity, treatment choice, or fluid, vasopressors, and inotrope amounts. CONCLUSIONS: Using HPI combined with diagnostic guidance on top of standard care significantly decreased hypotension severity in elective cardiac surgery patients compared with standard care.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Effect of a Machine Learning-Derived Early Warning Tool With Treatment Protocol on Hypotension During Cardiac Surgery and ICU Stay: The Hypotension Prediction 2 (HYPE-2) Randomized Clinical Trial
- Date Crossref
- 22/11/2024
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Amsterdam Neuroscience pays non établi dans la noticeStructure de recherche
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Amsterdam Cardiovascular Sciences pays non établi dans la noticeOrganisme public
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Amsterdam University of Applied Sciences pays non établi dans la noticeUniversité ou école supérieure
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University of Amsterdam Department of Anesthesiology pays non établi dans la noticeUniversité ou école supérieure
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Amsterdam University Medical Centers pays non établi dans la noticeÉtablissement de santé
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Amsterdam UMC Location Vrije Universiteit Amsterdam pays non établi dans la noticeÉtablissement de santé
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Medical Affairs pays non établi dans la noticeInstitution
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Laboratory of Experimental Intensive Care and Anesthesiology pays non établi dans la noticeStructure de recherche
Amsterdam Neuroscience, Amsterdam Cardiovascular Sciences et Amsterdam University of Applied Sciences, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.