The Hypotension Prediction Index in Free Flap Transplant in Head and Neck Surgery.

NCT05738603 | Recruiting

• 1 other identifier: 560/22
• Study Type: interventional
• Target: 206
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of the current study is to evaluate the effects of the Hypotension Prediction Index (HPI) on the degree of intraoperative hypotension in patients undergoing free flap surgery. The hypothesis is that implementation of the HPI algorithm will reduce the time-weighted average (TWA) intraoperative hypotension below a threshold of 65 mmHg (16), and to reveal the relationship between the episodes of hypotension and free flap viability and function.

Conditions

Hypotension; Head and Neck Cancer; Perioperative Complication; Postoperative Complications

Keywords

Hypotension; Hypotension Prediction Index; Free Flap Transplant; Head and Neck Cancer; Perioperative Complications

Outcome Measures

Primary Outcomes (1)

• TWA Mean Arterial Pressure (MAP) < 65 mmHg

  TWA - MAP \< 65 mmHg - time weighed average = (depth of hypotension in millimeters of mercury below a MAP of 65 mmHg x time in minutes spent below MAP of 65mmHg)/total duration of operation in minutes

  From the beginning of the anesthesia to the end of anesthesia

Secondary Outcomes (4)

• TWA - MAP < 60 mmHg

  From the beginning of the anesthesia to the end of anesthesia

• TWA - MAP < 55 mmHg

  From the beginning of the anesthesia to the end of anesthesia

• 30 day mortality

  30 days

• Length of hospitalisation

  From date of randomisation to the date of hospital discharge or date of death, whichever came first, assesed up to 3 months

Study Arms (2)

Standard Therapy Group

NO INTERVENTION

The standard therapy group patients will have invasive blood pressure monitoring + standard medical therapy. The therapeutic decision regarding treatment of hypotension, the use of fluids and vasopressors will be determined by the anaesthesia team. The decisions will be based on the information from the standard invasive blood pressure monitoring.

Hypotension Prediction Index Group

EXPERIMENTAL

The HPI-group will have the HPI based monitoring with the Acumen IQ sensor (Edwards Lifesciences) and the HPI algorithm connected also to the HemoSphere platform (Edwards Lifesciences). The hemodynamic management will be based on the HPI indications and the specific algorithm, which considers hypovolemia, impaired contractility and vasodilatation. An alert pops up on the monitor screen when the HPI values exceeds 85 and then the clinician needs to make therapeutic decision in order to avoid the hypotensive episode.

Device: Hypotension Prediction Index

Interventions

Hypotension Prediction Index DEVICE

Hemodynamic perioperative monitoring with the Hypotension Prediction Index

Hypotension Prediction Index Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients qualified to head and neck free flap surgery
• Written informed consent

You may not qualify if:

• Patients under 18 years
• Lack of health insurance
• Pregnancy
• Known history of congenital heart disease, severe aortic and/or mitral stenosis, heart failure and ejection fraction \< 35 %
• Persistent atrial fibrillation and other arrhythmias impairing arterial pressure-based cardiac output (APCO) monitoring

Sponsors & Collaborators

• Jakub Szrama: lead

Study Sites (1)

Department of Anesthesiology, Intensive Therapy and Pain Management

Poznan, Poznań, 61-355, Poland

RECRUITING

Related Publications (6)

• Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KG, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007 Aug;107(2):213-20. doi: 10.1097/01.anes.0000270724.40897.8e.

  PMID: 17667564 BACKGROUND

• Gu WJ, Hou BL, Kwong JSW, Tian X, Qian Y, Cui Y, Hao J, Li JC, Ma ZL, Gu XP. Association between intraoperative hypotension and 30-day mortality, major adverse cardiac events, and acute kidney injury after non-cardiac surgery: A meta-analysis of cohort studies. Int J Cardiol. 2018 May 1;258:68-73. doi: 10.1016/j.ijcard.2018.01.137. Epub 2018 Feb 2.

  PMID: 29429638 BACKGROUND

• Wijnberge M, Geerts BF, Hol L, Lemmers N, Mulder MP, Berge P, Schenk J, Terwindt LE, Hollmann MW, Vlaar AP, Veelo DP. 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 Mar 17;323(11):1052-1060. doi: 10.1001/jama.2020.0592.

  PMID: 32065827 BACKGROUND

• Maheshwari K, Shimada T, Yang D, Khanna S, Cywinski JB, Irefin SA, Ayad S, Turan A, Ruetzler K, Qiu Y, Saha P, Mascha EJ, Sessler DI. Hypotension Prediction Index for Prevention of Hypotension during Moderate- to High-risk Noncardiac Surgery. Anesthesiology. 2020 Dec 1;133(6):1214-1222. doi: 10.1097/ALN.0000000000003557.

  PMID: 32960954 BACKGROUND

• Grundmann CD, Wischermann JM, Fassbender P, Bischoff P, Frey UH. Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension. Acta Anaesthesiol Scand. 2021 Nov;65(10):1404-1412. doi: 10.1111/aas.13964. Epub 2021 Aug 31.

  PMID: 34322869 BACKGROUND

• Szrama J, Gradys A, Wozniak A, Nowak Z, Bartkowiak T, Lohani A, Zwolinski K, Koszel T, Kusza K. The Hypotension Prediction Index in Free Flap Transplant in Head and Neck Surgery: Protocol of a Prospective Randomized Controlled Trial. Life (Basel). 2025 Mar 4;15(3):400. doi: 10.3390/life15030400.

  PMID: 40141745 DERIVED

MeSH Terms

Conditions

Hypotension; Head and Neck Neoplasms; Postoperative Complications

Condition Hierarchy (Ancestors)

Vascular Diseases; Cardiovascular Diseases; Neoplasms by Site; Neoplasms; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Jakub Szrama, Ph.D.

  Poznan Univeristy of Medical Sciences, Department of Anesthesiology, Intensive Therapy

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Jakub Szrama, Ph.D.

CONTACT

+48 618691856; jakub.szrama@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: The studied patients will be blinded to the enrolled group.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Principal Investigator

Model Details: This prospective, randomized, controlled clinical trial will be performed in Poznan University of Medical Science Hospital. Patients fulfilling the inclusion criteria (see below) will be randomly assigned to receive invasive blood pressure monitoring + standard medical therapy (group A) or the hemodynamic monitoring with the Hypotension Prediction Index software (group B).

Study Record Dates

• First Submitted: January 15, 2023
• First Posted: February 22, 2023
• Study Start: September 1, 2024
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): December 1, 2026
• Last Updated: August 3, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PL (1)