Shedding Needed Light on a Black Box Approach to Prediction of Hypotension

Editorial| September 2024 Shedding Needed Light on a Black Box Approach to Prediction of Hypotension This article has an Audio Podcast Simon T. Vistisen, Ph.D.; Simon T. Vistisen, Ph.D. 1Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; and Aarhus University Hospital, Department of Anesthesiology and Intensive Care, Aarhus, Denmark. Search for other works by this author on: This Site PubMed Google Scholar Martin J. London, M.D.; Martin J. London, M.D. 2Department of Anesthesia and Perioperative Care, University of California, San Francisco, California. Search for other works by this author on: This Site PubMed Google Scholar Michael R. Mathis, M.D.; Michael R. Mathis, M.D. 3Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, Michigan. Search for other works by this author on: This Site PubMed Google Scholar Wilton A. van Klei, M.D., Ph.D.; Wilton A. van Klei, M.D., Ph.D. 4Department of Anesthesiology and Pain Management, Toronto General Hospital/ University Health Network Toronto, Toronto, Ontario, Canada; and Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. Search for other works by this author on: This Site PubMed Google Scholar Snehalata Huzurbazar, Ph.D.; Snehalata Huzurbazar, Ph.D. 5School of Nursing, Emory University, Atlanta, Georgia. Search for other works by this author on: This Site PubMed Google Scholar Matthias Jacquet-Lagrèze, M.D, M.Sc. Matthias Jacquet-Lagrèze, M.D, M.Sc. 6Service d'Anesthésie-Réanimation, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France; and CarMeN Laboratoire, Université Claude Bernard, Lyon, France. Search for other works by this author on: This Site PubMed Google Scholar Author and Article Information Accepted for publication May 21, 2024. This editorial accompanies the articles on pp. 443 and 453. This article has a related Infographic on p. A16. Address correspondence to Dr. London: Anesthesiology September 2024, Vol. 141, 421–424. https://doi.org/10.1097/ALN.0000000000005099 Connected Content Article: Comparison of Differences in Cohort (Forward) and Case Control (Backward) Methodologic Approaches for Validation of the Hypotension Prediction Index Article: Hypotension Prediction Index Is Equally Effective in Predicting Intraoperative Hypotension during Noncardiac Surgery Compared to a Mean Arterial Pressure Threshold: A Prospective Observational Study Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Simon T. Vistisen, Martin J. London, Michael R. Mathis, Wilton A. van Klei, Snehalata Huzurbazar, Matthias Jacquet-Lagrèze; Shedding Needed Light on a Black Box Approach to Prediction of Hypotension. Anesthesiology 2024; 141:421–424 doi: https://doi.org/10.1097/ALN.0000000000005099 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsAnesthesiology Search Advanced Search Topics: hypotension Monitoring hemodynamic parameters frequently or continuously is essential for safe anesthetic practice, aiming to detect and address potentially harmful physiologic changes promptly. Various thresholds for intraoperative hypotension based on mean arterial pressure (MAP) have been studied. A threshold of 65 mmHg is widely accepted due to its strong association with adverse outcomes.1 The Hypotension Prediction Index (Edwards Lifesciences, USA) was developed to predict intraoperative hypotension, defined as a MAP less than 65 mmHg for at least 1 min. The index is a proprietary "black box" algorithm based on 23 combinatorial pulse contour waveform features as reported in an initial development and validation study in Anesthesiology.2 Although subsequent clinical validation studies generally report excellent predictive performance,3 a variety of concerns have been raised regarding the appropriateness of statistical methodology used in its development and subsequent validation studies.4–6 Given the intense focus and rapid proliferation of artificial... You do not currently have access to this content.