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Abstract：
OBJECTIVE: Intraoperative hypotension (IOH) is associated with adverse outcomes. We therefore explored beliefs regarding IOH and barriers to its treatment. Secondarily, we assessed if an educational intervention and mandated mean arterial pressure (MAP), or the implementation of the Hypotension Prediction Index-software (HPI) were associated with a reduction in IOH.
METHODS: Structured interviews (n = 27) and questionnaires (n = 84) were conducted to explore clinicians\' beliefs and barriers to IOH treatment, in addition to usefulness of HPI questionnaires (n = 14). 150 elective major surgical patients who required invasive blood pressure monitoring were included in three cohorts to assess incidence and time-weighted average (TWA) of hypotension (MAP < 65 mmHg). Cohort one received standard care (baseline), the clinicians of cohort two had a training on hypotension and a mandated MAP > 65 mmHg, and patients of the third cohort received protocolized care using the HPI.
RESULTS: Clinicians felt challenged to manage IOH in some patients, yet they reported sufficient knowledge and skills. HPI-software was considered useful and beneficial. No difference was found in incidence of IOH between cohorts. TWA was comparable between baseline and education cohort (0.15 mmHg [0.05-0.41] vs. 0.11 mmHg [0.02-0.37]), but was significantly lower in the HPI cohort (0.04 mmHg [0.00 to 0.11], p < 0.05 compared to both).
CONCLUSIONS: Clinicians believed they had sufficient knowledge and skills, which could explain why no difference was found after the educational intervention. In the HPI cohort, IOH was significantly reduced compared to baseline, therefore HPI-software may help prevent IOH.
BACKGROUND: ISRCTN 17,085,700 on May 9th, 2019.
METHODS: Structured interviews (n = 27) and questionnaires (n = 84) were conducted to explore clinicians\' beliefs and barriers to IOH treatment, in addition to usefulness of HPI questionnaires (n = 14). 150 elective major surgical patients who required invasive blood pressure monitoring were included in three cohorts to assess incidence and time-weighted average (TWA) of hypotension (MAP < 65 mmHg). Cohort one received standard care (baseline), the clinicians of cohort two had a training on hypotension and a mandated MAP > 65 mmHg, and patients of the third cohort received protocolized care using the HPI.
RESULTS: Clinicians felt challenged to manage IOH in some patients, yet they reported sufficient knowledge and skills. HPI-software was considered useful and beneficial. No difference was found in incidence of IOH between cohorts. TWA was comparable between baseline and education cohort (0.15 mmHg [0.05-0.41] vs. 0.11 mmHg [0.02-0.37]), but was significantly lower in the HPI cohort (0.04 mmHg [0.00 to 0.11], p < 0.05 compared to both).
CONCLUSIONS: Clinicians believed they had sufficient knowledge and skills, which could explain why no difference was found after the educational intervention. In the HPI cohort, IOH was significantly reduced compared to baseline, therefore HPI-software may help prevent IOH.
BACKGROUND: ISRCTN 17,085,700 on May 9th, 2019.
摘要：
目的：术中低血压（IOH）与不良结局相关。因此，我们探讨了有关IOH的信念及其治疗障碍。其次，我们评估了教育干预和强制平均动脉压(MAP)，或低血压预测指数软件（HPI）的实施与IOH的减少有关。
方法：进行了结构化访谈（n=27）和问卷调查（n=84），以探索临床医生对IOH治疗的信念和障碍，除了HPI问卷的有用性(n=14)。150名需要进行有创血压监测的择期大手术患者被纳入三个队列，以评估低血压的发生率和时间加权平均值（TWA）（MAP<65mmHg）。队列1接受标准护理（基线），第2组的临床医生接受了低血压和强制MAP>65mmHg的培训，第三个队列的患者接受了使用HPI的原型治疗。
结果：临床医生对某些患者的IOH管理感到挑战，然而他们报告了足够的知识和技能。HPI软件被认为是有用和有益的。队列之间的IOH发生率没有差异。TWA在基线和教育队列之间具有可比性（0.15mmHg[0.05-0.41]vs.0.11mmHg[0.02-0.37])，但在HPI队列中显著较低(0.04mmHg[0.00至0.11]，与两者相比，p<0.05)。
结论：临床医生认为他们有足够的知识和技能，这可以解释为什么在教育干预后没有发现差异。在HPI队列中，与基线相比，IOH显著降低，因此，HPI软件可能有助于预防IOH。
背景：5月9日的ISRCTN17,085,700，2019.
方法：进行了结构化访谈（n=27）和问卷调查（n=84），以探索临床医生对IOH治疗的信念和障碍，除了HPI问卷的有用性(n=14)。150名需要进行有创血压监测的择期大手术患者被纳入三个队列，以评估低血压的发生率和时间加权平均值（TWA）（MAP<65mmHg）。队列1接受标准护理（基线），第2组的临床医生接受了低血压和强制MAP>65mmHg的培训，第三个队列的患者接受了使用HPI的原型治疗。
结果：临床医生对某些患者的IOH管理感到挑战，然而他们报告了足够的知识和技能。HPI软件被认为是有用和有益的。队列之间的IOH发生率没有差异。TWA在基线和教育队列之间具有可比性（0.15mmHg[0.05-0.41]vs.0.11mmHg[0.02-0.37])，但在HPI队列中显著较低(0.04mmHg[0.00至0.11]，与两者相比，p<0.05)。
结论：临床医生认为他们有足够的知识和技能，这可以解释为什么在教育干预后没有发现差异。在HPI队列中，与基线相比，IOH显著降低，因此，HPI软件可能有助于预防IOH。
背景：5月9日的ISRCTN17,085,700，2019.
