低血壓預測指數的臨床應用 – 人工智慧輔助機器學習運算邏輯

術中低血壓被認為是與術後並發症發展相關的主要促成因素例如急性腎損傷、心肌及腦部的傷害。由於IOH不僅與圍手術期發病率相關，而且還與圍手術期死亡率（這是僅次於缺血性心臟病和中風後的第三大全球因素）相關，因此應努力降低IOH的發生率和持續時間。因此，POQI（圍手術期質量倡議）的共識建議，對於接受非心臟手術的成年人，有充分的證據支持平均動脈壓應保持在60-70 毫米汞柱以上，以減少術後心肌和腎臟損傷，和死亡。考慮到即使短暫的術中低血壓可能也是有害的，例如麻醉誘導後和手術切開之前—通過預測生命體徵，將我們目前的做法從反應性方法（通過監護患者的實際血液動力學狀態）更改為主動性方法可能會有所幫助，尤其是因為患者經歷低血壓時間越長，則越有可能會對結果產生不利影響。醫療技術的當前進展包括使用基於機器學習的算法，低血壓預測指數(HPI）來分析大型數據集，以提供臨床上有用的信息。這樣的預測分析可以幫助證實這樣的主動方法。
圍手術期使用HPI的可行性研究提供了充分的證據，證明HPI觸發的目標導向治療方法可以減少IOH的發生率和持續時間。這可能是在這個新的十年中的重要研究之一，通過使用創新技術幫助進一步改善圍手術期患者的安全性。

Clinical Application of Hypotension Prediction Index – AI Assisted Machine Learning Algorithm

Intraoperative hypotension (IOH) is increasingly recognized as a major contributing factor associated with the development of postoperative complications in terms of renal, myocardial and possibly, cerebral injury. As IOH is not only associated with perioperative morbidity but with perioperative mortality as well—which is the 3rd greatest global contributor to deaths after ischemic heart disease and stroke —efforts should be made to reduce both the incidence and duration of IOH. Hence, consensus by POQI (Perioperative Quality Initiative) advises that for adults undergoing non-cardiac surgery, there is substantial evidence supporting that mean arterial pressure (MAP) should be kept above 60–70 mmHg in order to reduce postoperative myocardial and renal injury, and death. Given that even brief periods of IOH may be harmful—e.g. after induction of anesthesia and before surgical incision —it may be beneficial to change our current practice from a reactive approach (by monitoring the patient`s actual hemodynamic status) to a proactive approach, by predicting vital signs , especially since (cumulatively) the longer a patients “spends” in IOH, the more likely it is that this will adversely affect outcome . The current advances in medical technology include the use of machine-learning based algorithms, HPI (Hypotension Prediction Index) to analyze large datasets in order to provide clinically useful information. Such predictive analytics may help in substantiating such a proactive approach.

Feasibility studies on the use of HPI in the perioperative setting provides substantial evidence that a HPI-triggered goal-directed therapy approach may reduce the incidence and duration of IOH, which is a well-recognized factor that is associated with the development of postoperative morbidity and mortality. It may just be one of the very first studies in this new decade that helps improving perioperative patient safety further by using innovative technology such as the commercially available Hypotension Prediction Index.