Hypotension Prediction Index Guided Prevention of Intradialytic Hypotension During Intermittent Renal Replacement Therapy in Intensive Care Units

What this Trial Is About

This research evaluates whether using a Hypotension Prediction Index (HPI) to guide management can reduce low blood pressure events during prolonged intermittent renal replacement therapy (PIRRT) in critically ill patients. The study involves adults admitted to the medical ICU with acute kidney injury (AKI) or end-stage kidney disease (ESKD) who require PIRRT and have an arterial catheter for continuous monitoring. The trial is designed as a single-center, randomized, crossover controlled study to compare HPI-guided care with standard monitoring approaches. Participants undergo two PIRRT sessions, receiving either HPI-guided management first followed by standard care, or vice versa, with random assignment balanced by kidney status and vasopressor use. The HPI device, integrated into the Hemosphere system, predicts hypotension events before they happen to allow earlier interventions. Standard care involves conventional invasive blood pressure monitoring and clinical judgment, including physical exams and fluid or vasopressor adjustments. During the study, continuous real-time hemodynamic monitoring occurs, and researchers track blood pressure trends, frequency of hypotension events, fluid removal effectiveness, heart rhythm changes, and response times to treatments on days 1 and 3. The primary outcome is the time-weighted average mean arterial pressure below 65 mmHg. Safety and treatment responses are carefully observed, with participants involved throughout the ICU stay as per study timelines.

Using a Hypotension Prediction Index to Prevent Low Blood Pressure During Dialysis in ICU Patients