Hypotension Decision Assist (HDA)™

The Problem of Intra-operative Hypotension

Intra-operative hypotension (IOH) is a common and frequent occurrence in patients undergoing general anesthesia for non-cardiac surgery.  A 2014 study of almost 17,000 anesthetic records revealed that 26% of the surgical patients involved had a peri-operative systolic blood pressure of <80mmHg for >5minutes1

IOH is associated with

  • Post-operative mortality2
  • Acute kidney injury (AKI)
  • Myocardial injury (MI)

Studies have shown that 30-day mortality was strongly related to time-weighted average intraoperative MAP3.

The threshold for myocardial injury is a MAP <65mmHg. The threshold for renal injury may be higher, possibly nearer 75mmHg.  A few minutes of a MAP <55mmHg is associated with AKI and MI and have been demonstrated to increase markedly with prolonged intra-operative hypotension4.

“there does not appear to be any safe duration of a MAP less than 55 mmHg” (Walsh, 2013).

The Hypotension Decision Assist (HDA)™ solution

Hypotension Decision Assist (HDA)™ has been designed for and with anesthesiologists, to assist anesthesia healthcare professionals to manage the blood pressure, hemodynamic stability and the cardiovascular system during surgery where an arterial line is present and arterial pressure is being continuously monitored. HDA provides an intuitive visualization via a single at-a-glance screen.  You just connect HDA to your existing multiparameter patient monitor, with no additional calibration required and be ready to use HDA.

Expected Benefits of HDA

  • Assists anesthesiologists to manage blood pressure and the cardiovascular system including the detection and control of IOH within user defined limits
  • Contribute to reducing hospital costs: an independent study by Keuffel et al (2019) showed that controlling IOH more effectively could save between $119-$458 per non-cardiac surgical patient5

Only available in the USA

References

    1. Nair et al., “Anesthesia information management sytem-based near real-time decision support to manage intraoperative hypotension and hypertension.” Anesth Analg 2014; 118: 206–214
    2. Monk TG, Saini V, Weldon BC, Sigl JC. “Anesthetic management and one-year mortality after noncardiac surgery.” Anesth Analg 2005; 100: 4-10
    3. Mascha EJ, Yang D, Weiss S, Sessler DI. “Intraoperative Mean Arterial Pressure Variability and 30-day Mortality in Patients Having Noncardiac Surgery.” Anesthesiol 2015; 123:79–91
    4. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. “Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension.” Anesthesiol 2013; 119: 507–515
    5. Eric L. Keuffel, John Rizzo, Mitali Stevens, Candace Gunnarsson & Kamal Maheshwari (2019) “Hospital costs associated with intraoperative hypotension among non-cardiac surgical patients in the US: a simulation model”, Journal of Medical Economics, 22:7, 645-651

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