The recent article titled “Hypotension Prediction Index for Prevention of Hypotension during Moderate- to High-risk Noncardiac Surgery” explored whether a “hypotension prediction index algorithm” based on an arterial blood pressure waveform analysis can reduce the duration and severity of intraoperative hypotension. The authors suggested that the hypotension prediction index failed to prevent hypotension because of the following: inadequate warning time, a complex treatment algorithm, a set blood pressure threshold, and clinicians ignoring the algorithm recommendation. We agree with the authors’ above reasoning; however, we have some commentary and questions for the authors on their conclusions and plans for subsequent trials.

First, the authors conclude that the main reason the hypotension prediction index did not prevent hypotension is the inadequate warning time and that lowering the intervention alert threshold in the subsequent trial would increase the time...

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