4232895820260623
1537-19212026Jun23Journal of neurosurgical anesthesiologyJ Neurosurg AnesthesiolComparison of Intraoperative Hypotension Outcomes With and Without Hypotension Prediction Index Tool in Patients Undergoing Brain Tumor Surgery: A Randomized Controlled Trial.10.1097/ANA.0000000000001145Intraoperative hypotension (IOH) can affect patient outcomes following craniotomy. The Hypotension Prediction Index (HPI) can predict IOH in advance, enabling early, proactive management. We evaluated whether an HPI-integrated hemodynamic management protocol reduces IOH during brain tumor surgery.This single-center, parallel-group randomized controlled trial was registered prospectively with the Clinical Trial Registry-India (CTRI/2024/07/069939, dated 04/07/2024) and funded by the Indian Council of Medical Research. Consenting adult patients undergoing brain tumor decompression were randomized 1:1 to HPI-guided (n=90) or conventional care (control) (n=90) hemodynamic management. The primary outcome was duration of IOH (MAP<65 mm Hg). Secondary outcomes included time-weighted average (TWA) of IOH, episodes, severity, and timing of IOH, vasopressor use, myocardial ischemia, acute kidney injury, delirium, intensive care unit (ICU) stay, and hospital stay.Of 180 enrolled patients, 176 were analyzed (HPI n=86; control n=90). HPI guidance significantly reduced IOH duration (MAP<65 mm Hg: 600 [180 to 960] vs. 1820 [420 to 4620] s; P <0.001), TWA of MAP <65 mm Hg (0.10 [0.03 to 0.22] vs. 0.32 [0.07 to 1.01] mm Hg; P <0.001), and number of hypotensive episodes (4 [2 to 7] vs. 6 [2 to 13]; P =0.004). TWA of MAP<60 mm Hg and <55 mm Hg was also significantly lower in the HPI group ( P <0.001). The IOH duration was lesser in the HPI group than in the control group during both presurgical and surgical phases. Postoperative outcomes did not differ between groups.HPI-guided hemodynamic management significantly reduced the burden of IOH during brain tumor surgery.Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.FrancisThomasTNational Institute of Mental Health and Neurosciences, Bangalore, India.SriganeshKamathKMishraRajeeb KumarRKChakrabartiDhritimanDengJournal Article20260623
United StatesJ Neurosurg Anesthesiol89107490898-4921IMbrain neoplasmshemodynamicshypotensionintraoperative careneurosurgical proceduresThe authors have no funding or conflicts of interest to disclose.202621020264920266221343202662213432026622853aheadofprint4232895810.1097/ANA.000000000000114500008506-990000000-00250Dobson GP. Trauma of major surgery: a global problem that is not going away. Int J Surg Lond Engl. 2020;81:47–54. doi:10.1016/j.ijsu.2020.07.01710.1016/j.ijsu.2020.07.017Shirmohamadi E, Dolama RH, Mohammadzadeh N, et al. Intraoperative hypotension prediction in cardiac and noncardiac procedures: is HPI truly worthwhile? A systematic review and meta-analysis. BMC Anesthesiol. 2025;25:388. doi:10.1186/s12871-025-03250-410.1186/s12871-025-03250-4Wesselink EM, Kappen TH, Torn HM, et al. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018;121:706–721. doi:10.1016/j.bja.2018.04.03610.1016/j.bja.2018.04.036Tsoumpa M, Kyttari A, Matiatou S, et al. The use of the hypotension prediction index integrated in an algorithm of goal directed hemodynamic treatment during moderate and high-risk surgery. J Clin Med. 2021;10:5884. doi:10.3390/jcm1024588410.3390/jcm10245884Pilakouta Depaskouale MA, Archonta SA, Katsaros DM, et al. Beyond the debut: unpacking six years of Hypotension Prediction Index software in intraoperative hypotension prevention—a systematic review and meta-analysis. J Clin Monit Comput. 2024;38:1367–1377. doi:10.1007/s10877-024-01202-w10.1007/s10877-024-01202-wMohammadi I, Firouzabadi SR, Hosseinpour M, et al. Predictive ability of hypotension prediction index and machine learning methods in intraoperative hypotension: a systematic review and meta-analysis. J Transl Med. 2024;22:725. doi:10.1186/s12967-024-05481-410.1186/s12967-024-05481-4Acumen IQ sensor. Accessed February 5, 2026. https://www.edwards.com/healthcare-professionals/products-services/predictive-monitoring/acumen-iq-sensorFrancis T, Kamath S, Kumar RM, et al. Comparison of Intraoperative Hypotension Outcomes with and Without Hypotension Prediction Index Tool in Patients Undergoing Brain Tumour Surgery: A Study Protocol for a Randomised Controlled Trial. Neurol India. 2026;74:105–109. doi:10.4103/neurol-india.Neurol-India-D-25-0036710.4103/neurol-india.Neurol-India-D-25-00367Surgery Management Software. Accessed February 5, 2026. https://www.gehealthcare.com/products/software/perioperative-software?srsltid=AfmBOooTNfSDtt3ZNNXQuLaUfOFlDzmROaUj3qXpgAc5lYoDos8ukVflShah PJ, Agrawal P, Beldar RK. Intravenous norepinephrine and mephentermine for maintenance of blood pressure during spinal anaesthesia for caesarean section: an interventional double-blinded randomised trial. Indian J Anaesth. 2020;64(Suppl 4):S235–S241. doi:10.4103/ija.IJA_91_2010.4103/ija.IJA_91_20Pouska J, Kletecka J, Zatloukal J, et al. A protocol based on hypotension probability indicator vs. standard care to prevent intraoperative hypotension during supratentorial brain surgery: a prospective randomized pilot trial. Minerva Anestesiol. 2023;89:510–519. doi:10.23736/S0375-9393.23.17197-510.23736/S0375-9393.23.17197-5Hatib F, Jian Z, Buddi S, et al. Machine-learning algorithm to predict hypotension based on high-fidelity arterial pressure waveform analysis. Anesthesiology. 2018;129:663–674. doi:10.1097/ALN.000000000000230010.1097/ALN.0000000000002300Wijnberge M, Geerts BF, Hol L, et al. Effect of a machine learning-derived early warning system for intraoperative hypotension vs standard care on depth and duration of intraoperative hypotension during elective noncardiac surgery: the HYPE randomized clinical trial. JAMA. 2020;323:1052–1060. doi:10.1001/jama.2020.059210.1001/jama.2020.0592Frassanito L, Giuri PP, Vassalli F, et al. Hypotension prediction index guided goal directed therapy and the amount of hypotension during major gynaecologic oncologic surgery: a randomized controlled clinical trial. J Clin Monit Comput. 2023;37:4. doi:10.1007/s10877-023-01017-110.1007/s10877-023-01017-1Šribar A, Jurinjak IS, Almahariq H, et al. Hypotension prediction index guided versus conventional goal directed therapy to reduce intraoperative hypotension during thoracic surgery: a randomized trial. BMC Anesthesiol. 2023;23:101. doi:10.1186/s12871-023-02069-110.1186/s12871-023-02069-1Murabito P, Astuto M, Sanfilippo F, et al. Proactive management of intraoperative hypotension reduces biomarkers of organ injury and oxidative stress during elective non-cardiac surgery: a pilot randomized controlled trial. J Clin Med. 2022;11:392. doi:10.3390/jcm1102039210.3390/jcm11020392Schneck E, Schulte D, Habig L, et al. Hypotension Prediction Index based protocolized haemodynamic management reduces the incidence and duration of intraoperative hypotension in primary total hip arthroplasty: a single centre feasibility randomised blinded prospective interventional trial. J Clin Monit Comput. 2020;34:6. doi:10.1007/s10877-019-00433-610.1007/s10877-019-00433-6Yoshikawa Y, Maeda M, Kunigo T, et al. Effect of using hypotension prediction index versus conventional goal-directed haemodynamic management to reduce intraoperative hypotension in non-cardiac surgery: a randomised controlled trial. J Clin Anesth. 2024;93:111348. doi:10.1016/j.jclinane.2023.11134810.1016/j.jclinane.2023.111348Lorente JV, Ripollés-Melchor J, Jiménez I, et al. Intraoperative hemodynamic optimization using the hypotension prediction index vs. goal-directed hemodynamic therapy during elective major abdominal surgery: the Predict-H multicenter randomized controlled trial. Front Anesthesiol. 2023;2:1193886. doi:10.3389/fanes.2023.119388610.3389/fanes.2023.1193886Lai CJ, Cheng YJ, Han YY, et al. Hypotension prediction index for prevention of intraoperative hypotension in patients undergoing general anesthesia: a randomized controlled trial. Perioper Med. 2024;13:57. doi:10.1186/s13741-024-00414-710.1186/s13741-024-00414-7Maheshwari K, Shimada T, Yang D, et al. Hypotension prediction index for prevention of hypotension during moderate- to high-risk noncardiac surgery. Anesthesiology. 2020;133:1214–1222. doi:10.1097/ALN.000000000000355710.1097/ALN.0000000000003557Sriganesh K, Francis T, Mishra RK, et al. Hypotension prediction index for minimising intraoperative hypotension: a systematic review and meta-analysis of randomised controlled trials. Indian J Anaesth. 2024;68:11. doi:10.4103/ija.ija_677_2410.4103/ija.ija_677_24Ryu T. Fluid management in patients undergoing neurosurgery. Anesth Pain Med. 2021;16:215–224. doi:10.17085/apm.2107210.17085/apm.21072Walsh M, Devereaux PJ, Garg AX, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507–515. doi:10.1097/ALN.0b013e3182a10e2610.1097/ALN.0b013e3182a10e26Bette S, Wiestler B, Wiedenmann F, et al. Safe brain tumor resection does not depend on surgery alone - role of hemodynamics. Sci Rep. 2017;7:5585. doi:10.1038/s41598-017-05767-210.1038/s41598-017-05767-2Beqiri E, García-Orellana M, Politi A, et al. Cerebral autoregulation derived blood pressure targets in elective neurosurgery. J Clin Monit Comput. 2024;38:649–662. doi:10.1007/s10877-023-01115-010.1007/s10877-023-01115-0