HPI Algorithm for the Prevention of IOH During Spinal Surgery [HPIFPIOH]

NCT ID: NCT05341167

Last Updated: 2025-03-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

85 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-05-11

Study Completion Date

2024-10-10

Brief Summary

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The aim of this study is to investigate the hypothesis that the use of the Hypotension Prediction Index algorithm (HPI) can reduce intraoperative hypotension (IOH) in adult patients undergoing spinal surgery in the prone position under general anesthesia, as well as to explore its effect on in-hospital postoperative morbidity and mortality.

Detailed Description

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The study is a Prospective Randomized clinical trial. Adult patients (\>18y) undergoing spinal surgery in the prone position under general anesthesia will be included.

The patients will be randomized using a computer-generated, permuted block randomization with a 1:1 allocation into two groups.

Intervention group: in this group, the HPI algorithm will be used in order to prevent hypotensive episodes Control group: in this group standard anesthetic care will be provided. Hypotensive episodes will be treated with vasoactive agents and fluids.

All patients will receive the same type of anaesthesia (TIVA with propofol) and monitoring including Patient State Index (PSI), non-invasive monitoring of blood pressure, SpO2, continuous electrocardiographic monitoring, ETCO2 and urinary output. Additionally, invasive continuous measurement of the patient's blood pressure will be available via radial artery catheterization. The arterial catheter will be connected to both the standard monitor and the platform which includes the HPI software. Arterial blood gas testing will be performed on an hourly basis.

Intraoperative recordings include PSI values, hemodynamic parameters every 10-15 minutes and urinary output every hour. Hemodynamic parameters will also be collected electronically from the monitor. The total doses of propofol, opioids/sedatives, fluids and vasoactive agents will also be recorded, as well as the estimated blood loss.

In this study, time-weighted average (TWA) in hypotension will be calculated in all patients.\[TWA= depth of hypotension x time spent in hypotension / total surgery time\].

Postoperatively Blood sampling for hs-TropI will be collected after the surgical procedure and during the following 3 postoperative days. If an increase in the levels hs-Trop I is noted the patient will be inquired for symptoms of myocardial ischemia and a new ECG will be performed. A cardiology consultation will be requested, if necessary.

Creatinine levels and urinary output will be monitored during the first 2 postoperative days. Acute kidney injury will be assessed according to the AKIN classification.

All in-hospital incidents and in-hospital mortality will also be documented.

Conditions

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Intraoperative Hypotension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective, Randomized, Double-Blinded clinical trial
Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
Not aware of the study group

Study Groups

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Intervention group:

The HPI algorithm will be used in order to prevent hypotensive episodes. When the HPI is greater than 85%, the anesthesiologist will have to intervene within the next 2 minutes taking the hemodynamic parameters available into consideration, as well as the treatment protocol that has been designed according to current literature

Group Type ACTIVE_COMPARATOR

HPI algorithm using Edwards device https://www.edwards.com/gb/devices/decision-software/hpi

Intervention Type DEVICE

The HPI algorithm will be used in order to prevent hypotensive episodes. When the HPI is greater than 85%, the anesthesiologist will have to intervene within the next 2 minutes taking the hemodynamic parameters available into consideration, as well as the treatment protocol that has been designed according to current literature

Vasoactive Agent

Intervention Type DRUG

Hypotensive episodes will be treated with vasoactive agents and fluids. The HPI algorithm recordings will be blinded and will not be available to the anesthesiologist for the duration of the operation.

Control group:

Hypotensive episodes will be treated with vasoactive agents and fluids according to the standard clinical practice. The HPI algorithm recordings will be blinded and will not be available to the anesthesiologist for the duration of the operation.

Group Type OTHER

Vasoactive Agent

Intervention Type DRUG

Hypotensive episodes will be treated with vasoactive agents and fluids. The HPI algorithm recordings will be blinded and will not be available to the anesthesiologist for the duration of the operation.

Interventions

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HPI algorithm using Edwards device https://www.edwards.com/gb/devices/decision-software/hpi

The HPI algorithm will be used in order to prevent hypotensive episodes. When the HPI is greater than 85%, the anesthesiologist will have to intervene within the next 2 minutes taking the hemodynamic parameters available into consideration, as well as the treatment protocol that has been designed according to current literature

Intervention Type DEVICE

Vasoactive Agent

Hypotensive episodes will be treated with vasoactive agents and fluids. The HPI algorithm recordings will be blinded and will not be available to the anesthesiologist for the duration of the operation.

Intervention Type DRUG

Other Intervention Names

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noradrenaline phenylephrine noradrenaline phenylephrine

Eligibility Criteria

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Inclusion Criteria

* Adult patients undergoing scheduled spine surgery performed in prone position under general anaesthesia

Exclusion Criteria

* Heart failure with reduced ejection fraction (LVEF\<35%)
* Severe aortic and/or mitral regurgitation
* Persistent atrial fibrillation or other significant cardiac arrhythmias
* Significant preoperative hypotension
* End-stage renal disease on dialysis/RRT
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Attikon Hospital

OTHER

Sponsor Role lead

Responsible Party

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Paraskevi Matsota

Prof of Anestehsiology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Paraskevi Matsota, Prof

Role: PRINCIPAL_INVESTIGATOR

2nd Department of Anesthesiology, Attikon University Hospital

Locations

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General Hospital of Athens "Georgios Gennimatas"

Athens, Attica, Greece

Site Status

Attikon Hospital

Athens, , Greece

Site Status

Countries

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Greece

References

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Pilakouta Depaskouale MA, Archonta SA, Moutafidou SKappa, Paidakakos NA, Dimakopoulou AN, Matsota PK. Effectiveness of hypotension prediction index software in reducing intraoperative hypotension in prolonged prone-position spine surgery: a single-center clinical trial. J Clin Monit Comput. 2025 Oct;39(5):875-887. doi: 10.1007/s10877-025-01303-0. Epub 2025 May 23.

Reference Type DERIVED
PMID: 40410627 (View on PubMed)

Other Identifiers

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HPIFPIOH

Identifier Type: -

Identifier Source: org_study_id

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