Postoperative hypotension in the post-anesthesia care unit (PACU) is common and linked to adverse outcomes. The Hypotension Prediction Index (HPI) predicts hypotensive events intraoperatively, but its PACU application is unexplored. This study aims to investigate the effectiveness of HPI-guided monitoring in preventing PACU hypotension.
Age ≥ 19 years
Undergoing elective surgery under general anesthesia
Presence of intra-arterial catheter at the end of surgery
Expected PACU stay of ≥ 30 minutes
Immediate postoperative ICU admission
Use of vasopressors during emergence from anesthesia
ASA physical status classification of V
Known contraindications to arterial line placement
Parallel
Hypotension Prediction Index Monitoring
DeviceHPI monitoring is performed using the Edwards Lifesciences HemoSphere platform to provide real-time hypotension prediction based on arterial pressure waveform analysis. Interventions such as fluid bolus or vasopressor are administered per protocol when HPI ≥ 85.
Standard PACU Monitoring
Other interventionStandard monitoring in the post-anesthesia care unit (PACU), including non-invasive blood pressure, heart rate, and oxygen saturation measurements. No Hypotension Prediction Index (HPI) monitoring is used. Interventions are performed according to routine institutional practices.
Incidence of Postoperative Hypotension in the PACU
Defined as mean arterial pressure (MAP) \< 65 mmHg lasting for more than 1 minute during the patient's stay in the post-anesthesia care unit (PACU).
Time to First Hypotensive Episode
Time elapsed from PACU admission to the first hypotensive episode (MAP \< 65 mmHg for \>1 minute).
Vasopressor Use
Percentage of patients receiving any vasopressor during PACU stay.
PACU Length of Stay
Total duration (in minutes) of PACU stay.
Incidence of Postoperative Complications
Occurrence of postoperative complications during PACU stay, including nausea/vomiting and acute kidney injury as defined by KDIGO criteria.
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