Proactive haemodynamic management using the hypotension prediction index during caesarean section: a randomised controlled study.

Summary

In this three-arm randomized study of 171 cesarean patients under spinal anesthesia, HPI-guided management significantly reduced time-weighted hypotension versus oscillometric or continuous non-invasive arterial pressure monitoring. Maternal nausea and vomiting were also less frequent without an increase in hypertension.

Key Findings

• Time-weighted average hypotension was lowest with HPI guidance (0.08 mmHg) versus oscillometric (0.89 mmHg) and continuous non-invasive monitoring (0.30 mmHg), p < 0.001.
• Maternal nausea and vomiting were more frequent with oscillometric monitoring compared to HPI and continuous non-invasive groups (nausea p = 0.038; vomiting p = 0.023).
• No increase in hypertension despite proactive vasopressor treatment guided by HPI.

Clinical Implications

Adopting HPI-guided therapy during cesarean section can reduce intraoperative hypotension and emesis, potentially improving maternal experience and safety while standardizing vasopressor use.

Limitations

• Blinding of monitoring modality was not feasible, introducing performance bias risk
• Single surgical context (elective cesarean under spinal anesthesia) may limit generalizability

Future Directions

Multicenter trials to validate HPI-guided protocols across obstetric populations, assess neonatal outcomes, cost-effectiveness, and integration with closed-loop vasopressor systems.