Mean Arterial Pressure Alarm Noninferior to Hypotension Prediction Index in Surgical Trial

A single-center, blinded randomized noninferiority trial published in Anesthesiology compared two alarm strategies for proactive blood pressure management during moderate- or high-risk elective noncardiac surgery. Adults receiving continuous invasive arterial pressure monitoring were assigned to a mean arterial pressure (MAP) alarm below 72 mmHg or a Hypotension Prediction Index alarm above 85. The primary endpoint was cumulative hypotensive exposure, measured as the area under the MAP threshold of 65 mmHg.

Among 143 participants included in the final analysis, median hypotensive exposure was 3.75 mmHg·min (IQR, 0.00–22.62) with the MAP alarm and 4.00 mmHg·min (IQR, 0.00–19.00) with the prediction index. The log-transformed mean difference was 0.03 (95% CI, −0.24 to 0.29); the lower confidence bound exceeded the prespecified noninferiority margin of −0.4. No differences were detected in secondary hemodynamic measures, alarm characteristics, medications, fluids, or patient outcomes, including acute kidney injury, myocardial injury, and 30-day mortality.

These findings support a MAP alarm below 72 mmHg as an alternative to the prediction index in this monitored surgical population. However, the single-center design and small sample limit generalizability. Noninferiority on a hemodynamic endpoint does not establish equivalent protection against postoperative complications, and the supplied report does not provide an economic analysis to substantiate cost-effectiveness.