Acumen Hypotension Prediction Index software

The Acumen Hypotension Prediction Index (HPI) software is a
first-of-its-kind technology that provides clinicians with information regarding the likelihood of a patient trending toward a hypotensive event.*

*A hypotensive event is defined as MAP <65 mmHg for a duration of at least one minute.
Acumen Hypotension Prediction Index software

Edwards Lifesciences has a heritage of partnering with clinicians to bring advancements in patient care to the market. That heritage is at the core of the Acumen Hypotension Prediction Index software. Developed in partnership with clinicians across the world and the first in a new category of products, Acumen Hypotension Prediction Index software offers the only predictive monitoring parameter for hypotension that is available in Europe.

 Acumen Hypotension Prediction Index Software

This first-of-its-kind predictive decision support software detects the likelihood of a hypotensive event before it occurs. Additionally HPI provides insights into the root causes of the event and helps you identify the best potential course of action for your patient.

Know more about the risks of hypotension.

As part of the Acumen decision support suite, the Acumen Hypotension Prediction Index software is unlocked with the Acumen IQ sensor.

Three key elements of the Acumen Hypotension Prediction Index software

HPI parameter

HPI Parameter

The HPI parameter displays a value ranging from 0 to 100, with higher values indicating greater likelihood of a hypotensive event.*

The proprietary algorithm — developed using data from almost 59,000 hypotensive events and over 144,000 non-hypotensive events — coupled with machine learning techniques, potentially detects hypotension even before it occurs. The HPI parameter value is updated every 20 seconds, providing continual predictive insights into developing hypotensive events.

The diagnostic performance of the HPI parameter was assessed through clinical validation studies:

Summary of Clinical Validation Studies

The full table of Results of Clinical Validation studies may be found in Table 12-6 in the Operator's Manual.

  1. Specificity: ratio of true negatives to total number of non-events (negatives) with a negative defined as a data point that is at least 20 minutes away from any hypotensive event
  2. PPV
  3. Sensitivity: ratio of true positives to total number of events (positives) with positive defined as data point that is at most 5 minutes prior to a hypotensive event.
  4. NPV

HPI high alert popup

HPI high alert popup

The HPI Alert warns you when your patient is trending toward or experiencing a hypotensive event.

The Alert pops-up when the HPI parameter exceeds 85 for two consecutive 20-second updates or reaches 100 in any particular update. The Alert popup window will appear, prompting you to review the patient's hemodynamics using the HPI secondary screen.

HPI secondary screen

If your patient is trending toward a hypotensive event, or is experiencing one, you may want to investigate the root cause in order to proactively inform a potential course of action. The advanced hemodynamic pressure and flow parameters on the HPI secondary screen provides information to investigate and identify the root causes of developing hypotensive events.

HPI secondary screen

The HPI secondary screen is accessed through the HPI high alert popup, by touching the HPI Information Bar (when enabled), by pressing the button on the HPI Key Parameter, or at any other time through the Clinical Actions menu on the monitor. The HPI secondary screen displays consolidated values for the patient's clinical parameters of MAP, CO, SVR, PR, SV, and SVV as well as two additional indicators of contractility and afterload to provide a complete hemodynamic profile of the patient. The advanced hemodynamic parameters on the secondary screen are arranged visually by preload, contractility, and afterload.

These advanced hemodynamic parameters provides you potential insights into the cause of a hypotensive event.

Preload

Preload

Stroke volume variation (SVV)

The percent difference between minimum and maximum SV during a respiratory cycle. SVV serves as an accurate marker of position status on the Frank-Starling curve.

Contractility

Contractility

dP/dt

A sensitive measure of changes in the contractility of the left ventricle.

Afterload

Afterload

Dynamic arterial elastance (Eadyn)

The ratio of pulse pressure variation to stroke volume variation (PPV/SVV).

HPI brochure

*A hypotensive event is defined as MAP <65 mmHg for a duration of at least one minute.
Risk of hypotension

In noncardiac surgery patients, research findings have revealed strong associations between intraoperative hypotension and elevated risk of both acute kidney injury (AKI) and myocardial injury after noncardiac surgery (MINS).1,2,3

MINS — the most common cardiovascular complication that occurs after noncardiac surgery — is the leading cause of mortality within one month following surgery.1,4 It is a substantial public health issue.4

 Risk of hypotension

More than 200 million adults across the world will undergo noncardiac surgery annually, and this number continues to increase each year.5,6 Globally, every year an estimated 8 million patients over 45 years old — more than 1 in 12 patients — suffer myocardial injury after noncardiac surgery.4,6,7

Lowest MAP (mmHg)

Once a patient’s mean arterial pressure (MAP) reaches 65 mmHg, it only takes 10 minutes of exposure to see higher associations between intraoperative hypotension and MINS.1

Lowest MAP (mmHg)

Additionally, if a patient's MAP reaches 50 mmHg, it only takes one minute of exposure to see a significant escalation of MINS making early identification of a hypotensive event critical.1

Acumen Hypotension Prediction Index software is the first predictive technology that provides you with information regarding the likelihood of a patient trending toward a hypotensive event* and assists you in understanding the root cause of deteriorating hemodynamic stability.

*A hypotensive event is defined as MAP <65 mmHg for a duration of at least one minute.
The Acumen IQ sensor unlocks the Acumen Hypotension Prediction Index feature
Acumen IQ

The Acumen IQ sensor — part of the Acumen family of hemodynamic sensors — unlocks the Hypotension Prediction Index software. The minimally-invasive Acumen IQ sensor connects to a radial arterial line. The Acumen IQ system automatically updates advanced parameters every 20 seconds, reflecting rapid physiological changes in moderate-to high-risk surgery. Advanced hemodynamic parameters provided by the Acumen IQ sensor offer you continuous insight into your patient’s hemodynamic status.

ModelDescriptionLengthUnits
AIQS8 Acumen IQ sensor 84 in / 213 cm EA
AIQS85 Acumen IQ sensor 84 in / 213 cm 5
AIQS6 Acumen IQ sensor 60 in / 152 cm EA
AIQS65 Acumen IQ sensor 60 in / 152 cm 5
Edwards clinical education

Hemodynamic education for sustained clinical advancement

With a long-term commitment to improving the quality of care for surgical and critical care patients through education, Edwards Clinical Education meets you no matter where you are in the learning process — with a continuum of resources and tools that continuously support you as you solve the clinical challenges facing you today, and in the future.

For more educational information

Relevant podcasts on Intraoperative Hypotension (IOH)

The TopMedTalk podcast is a leading source of high value medical discussion and education in Anaesthesia, Perioperative Care and Enhanced Recovery. They have featured interviews with key opinion leaders, academics, medical practitioners and policy makers. Please find below a list of relevant podcasts on hypotension and Hypotension Prediction Index (HPI) software.

...

Prehab Periop World Congress:

Feras Hatib, Simon Davis

...

Prehab Periop World Congress:

Joff Lacey, Tim Miller

...

Prehab Periop World Congress:

Feras Hatib

...

Prehab Periop World Congress:

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References:
  1. Salmasi, V., Maheshwari, K., Yang, G., Mascha, E.J., Singh, A., Sessler, D.I., & Kurz, A. (2017). Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney injury and myocardial injury. Anesthesiology, 126(1), 47-65.
  2. Sun, L.Y., Wijeysundera, D.N., Tait, G.A., & Beattie, W.S. (2015). Association of Intraoperative Hypotension with Acute Kidney Injury after Elective non-cardiac Surgery. Anesthesiology, 123(3), 515-523.
  3. Walsh, M., Devereaux, P.J., Garg, A.X., Kurz, A., Turan, A., Rodseth, R.N., Cywinski, J., Thabane, L., & Sessler, D.I. (2013). Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after non-cardiac Surgery. Anesthesiology, 119(3), 507-515.
  4. Kahn, Alonso-Coello and Devereaux, Myocardial injury after non-cardiac surgery, Curr Opin Cardiol, 2014, 29:307-311
  5. Devereaux and Sessler, Cardiac complications in patients undergoing major non-cardiac surgery, N Engl J Med, 2015, 373(23):2258-2269.
  6. Sellers, D., Srinivas, C., Djaiani, G. (2018). Cardiovascular complications after non-cardiac surgery. Anaesthesia, 73 (Suppl. 1), 34 - 42.
  7. van Waes, J., Nathoe, H., Graaff, J., Kemperman, H., de Borst, G., Peelen, L., van Klei, W. (2013). Myocardial Injury After Noncardiac Surgery and its Association With Short-Term Mortality. Circulation, 127, 2264 - 2271.

For professional use

For professional use

See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse event.

Edwards Lifesciences devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity.

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