Comparison of Intraoperative Hypotension Outcomes With and Without Hypotension Prediction Index Tool in Patients Undergoing Brain Tumor Surgery: A Randomized Controlled Trial.

Authors

Thomas Francis, Kamath Sriganesh, Rajeeb Kumar Mishra, Dhritiman Chakrabarti

Published in

Journal of neurosurgical anesthesiology. Jun 23, 2026. Epub Jun 23, 2026.

Abstract

Intraoperative hypotension (IOH) can affect patient outcomes following craniotomy. The Hypotension Prediction Index (HPI) can predict IOH in advance, enabling early, proactive management. We evaluated whether an HPI-integrated hemodynamic management protocol reduces IOH during brain tumor surgery.
This single-center, parallel-group randomized controlled trial was registered prospectively with the Clinical Trial Registry-India (CTRI/2024/07/069939, dated 04/07/2024) and funded by the Indian Council of Medical Research. Consenting adult patients undergoing brain tumor decompression were randomized 1:1 to HPI-guided (n=90) or conventional care (control) (n=90) hemodynamic management. The primary outcome was duration of IOH (MAP<65 mm Hg). Secondary outcomes included time-weighted average (TWA) of IOH, episodes, severity, and timing of IOH, vasopressor use, myocardial ischemia, acute kidney injury, delirium, intensive care unit (ICU) stay, and hospital stay.
Of 180 enrolled patients, 176 were analyzed (HPI n=86; control n=90). HPI guidance significantly reduced IOH duration (MAP<65 mm Hg: 600 [180 to 960] vs. 1820 [420 to 4620] s; P<0.001), TWA of MAP <65 mm Hg (0.10 [0.03 to 0.22] vs. 0.32 [0.07 to 1.01] mm Hg; P<0.001), and number of hypotensive episodes (4 [2 to 7] vs. 6 [2 to 13]; P=0.004). TWA of MAP<60 mm Hg and <55 mm Hg was also significantly lower in the HPI group (P<0.001). The IOH duration was lesser in the HPI group than in the control group during both presurgical and surgical phases. Postoperative outcomes did not differ between groups.
HPI-guided hemodynamic management significantly reduced the burden of IOH during brain tumor surgery.

PMID:
42328958
Bibliographic data and abstract were imported from PubMed on 22 Jun 2026.

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