AB268. SOH26AB_0079. The introduction of continuous non-invasive blood pressure and advanced haemodynamic monitoring for colorectal surgery

Background: Major elective colorectal surgeries are complex, high-risk, and lengthy procedures. Traditionally, invasive arterial blood pressure monitors are inserted for assessment of cardiovascular status, allowing for adjustment of fluids and medications to maintain haemodynamic stability. New technologies have been developed that can provide continuous non-invasive arterial blood pressure and advanced haemodynamic monitoring. These monitoring systems use predictive software to help identify and treat the cause of haemodynamic instability, therefore reducing intraoperative hypotension. The hypotension prediction index (HPI) provides a value ranging from 0 to 100. Higher HPI values indicate an increased likelihood of a hypotensive event. If the HPI parameter value exceeds 85 for two consecutive 20-second updates or reaches 100 at any time, a prompt will appear to review the patient. This software also contains an algorithm to assist in the identification and management of the cause of a hypotensive event. This study evaluated the introduction of non-invasive blood pressure and advanced haemodynamic monitoring in colorectal surgery.

Methods: The anaesthetic department sought to improve perioperative blood pressure monitoring hardware. Having discussed various options and reviewing multiple software systems available, the department acquired an Edwards Acumen IQ cuff and monitoring system. Stakeholders decided to introduce and train departmental staff on the set up and use of the hardware and monitoring system. Major elective colorectal surgery was identified as the ideal surgery to trial the introduction of the new monitoring system.

Results: Following its introduction, 10 major colorectal cases have been performed using the new monitoring system.

Conclusions: The introduction of HPI software has provided an alternative non-invasive method of arterial blood pressure monitoring during major surgery. With the predictive software, we were able to safely monitor patients throughout their surgery. It provided clinicians with detailed cardiovascular status and the ability to predict intraoperative hypotension. Thus far, it has shown similar outcomes for our patients compared with invasive arterial monitoring.

Keywords: Non-invasive arterial blood pressure monitoring; hypotension prediction index (HPI); advanced haemodynamic monitoring; predictive software; colorectal surgery