Intraoperative hypotension prediction has been increasingly emphasized due to its potential clinical value in reducing organ injury and the broad availability of large-scale patient datasets and powerful machine learning tools. Hypotension prediction methods can mitigate low blood pressure exposure time. However, they have yet to be convincingly demonstrated to improve objective outcomes; furthermore, they have recently become controversial. This review presents the current state of intraoperative hypotension prediction and makes recommendations on future research. We begin by overviewing the current hypotension prediction methods, which generally rely on the prevailing mean arterial pressure as one of the important input variables and typically show good sensitivity and specificity but low positive predictive value in forecasting near-term acute hypotensive events. We make specific suggestions on improving the definition of acute hypotensive events and evaluating hypotension prediction methods, along with general proposals on extending the methods to predict reduced blood flow and treatment effects. We present a start of a risk-benefit analysis of hypotension prediction methods in clinical practice. We conclude by coalescing this analysis with the current evidence to offer an outlook on prediction methods for intraoperative hypotension. A shift in research toward tailoring hypotension prediction methods to individual patients and pursuing methods to predict appropriate treatment in response to hypotension appear most promising to improve outcomes.

中文翻译：

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术中低血压预测：当前方法、争议和研究展望。


由于其在减少器官损伤方面的潜在临床价值以及大规模患者数据集和强大机器学习工具的广泛可用性，术中低血压预测越来越受到重视。低血压预测方法可以减轻低血压暴露时间。然而，它们尚未被令人信服地证明可以改善客观结果;此外，它们最近也引起了争议。本文介绍了术中低血压预测的现状，并对未来的研究提出了建议。我们首先概述了当前的低血压预测方法，这些方法通常依赖于普遍的平均动脉压作为重要的输入变量之一，并且在预测近期急性低血压事件时通常表现出良好的敏感性和特异性，但阳性预测值较低。我们提出了关于改进急性低血压事件定义和评估低血压预测方法的具体建议，并就扩展预测血流减少和治疗效果的方法提出了一般性建议。我们提出了临床实践中低血压预测方法的风险收益分析的起点。最后，我们将此分析与当前证据相结合，为术中低血压的预测方法提供展望。研究转向为个体患者量身定制低血压预测方法，并寻求预测针对低血压的适当治疗的方法，似乎最有希望改善结果。