(1) Background: The Hypotension Prediction Index (HPI) is an algorithm that predicts hypotension, defined as mean arterial pressure (MAP) less than 65 mmHg for at least 1 min, based on arterial waveform features. We tested the hypothesis that the use of this index reduces the duration and severity of hypotension during noncardiac surgery. (2) Methods: We enrolled adults having moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring. Participating patients were randomized 1:1 to standard of care or hemodynamic management with HPI guidance with a goal directed hemodynamic treatment protocol. The trigger to initiate treatment (with fluids, vasopressors, or inotropes) was a value of HPI of 85 (range, 0–100) or higher in the intervention group. Primary outcome was the amount of hypotension, defined as time-weighted average (TWA) MAP less than 65 mmHg. Secondary outcomes were time spent in hypertension defined as MAP more than 100 mmHg for at least 1 min; medication and fluids administered and postoperative complications. (3) Results: We obtained data from 99 patients. The median (IQR) TWA of hypotension was 0.16 mmHg (IQR, 0.01–0.32 mmHg) in the intervention group versus 0.50 mmHg (IQR, 0.11–0.97 mmHg) in the control group, for a median difference of −0.28 (95% CI, −0.48 to −0.09 mmHg; p = 0.0003). We also observed an increase in hypertension in the intervention group as well as a higher weight-adjusted administration of phenylephrine in the intervention group. (4) Conclusions: In this single-center prospective study of patients undergoing elective noncardiac surgery, the use of this prediction model resulted in less intraoperative hypotension compared with standard care. An increase in the time spent in hypertension in the treatment group was also observed, probably as a result of overtreatment. This should provide an insight for refining the use of this prediction index in future studies to avoid excessive correction of blood pressure.

Intraoperative hypotension is common and has been associated with adverse events. Although association does not imply causation, predicting and preventing hypotension may improve postoperative outcomes. This review summarizes current evidence on the development and validation of an artificial intelligence predictive algorithm, the Hypotension Prediction (HPI) (formerly known as the Hypotension Probability Indicator). This machine learning model can arguably predict hypotension up to 15 min before its occurrence. Several validation studies, retrospective cohorts, as well as a few prospective randomized trials, have been published in the last years, reporting promising results. Larger trials are needed to definitively assess the usefulness of this algorithm in optimizing postoperative outcomes.

Background: Lung resection is the primary treatment option for many patients with lung cancer; however, it is a high-risk surgery with many potentially lethal perioperative complications. The aim of this review is to examine the capability of forced expiratory volume in one second (FEV1), diffusing capacity of the lung for carbon monoxide (DLCO), maximal oxygen uptake in exercise (VO_2max), and maximal inspiratory and expiratory pressures (PI_max and PE_max, respectively) to predict postoperative lung function. Methods: A literature review was performed using PubMed and the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines. The research included articles after 2000. Experimental studies on animals, studies before 2000, and studies in a language other than English were excluded. Results: A total of 11 studies were included in this review. The main findings were highlighted. In addition, the optimal threshold values of FEV1, DLCO, VO_2max, and PI_max as well as PE_max were discussed. Conclusions: Preoperative FEV1, DLCO, VO_2max, and PI_max as well as PE_max have all proven to be independent risk factors for the prediction of postoperative morbidity, mortality, and cardiopulmonary complications after lung resection surgery.

Background/Objectives: Acute kidney injury (AKI) is a syndrome characterized by impaired kidney function, which is associated with reduced survival and increased morbidity. Central venous pressure (CVP) is a widely used hemodynamic parameter for assessing the volume status of patients and evaluating their response to fluid resuscitation. This systematic review aims to analyze various prospective and retrospective observational and controlled trials to determine the association between CVP and the risk of developing AKI in patients undergoing cardiac surgery. Additionally, it examines whether elevated CVP serves as an accurate predictor of AKI in this patient population. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using PubMed as the primary database. The search focused on studies published after 2014 that included adult patients undergoing cardiac surgery with reported measurements of CVP and kidney function assessment. Studies conducted on animals, pediatric populations, those published before 2014, or in languages other than English were excluded from the review. Results: Through the analysis of 21 studies, a clear association between higher CVP and increased AKI risk emerged. The most critical CVP thresholds identified were 10 mmHg, 12 mmHg, 14 mmHg, and 20 mmHg, with risk increasing progressively beyond these values. CVP ≥ 10 mmHg was the most commonly reported cutoff for elevated AKI risk, showing 1.42 to 4.53 times increased odds. CVP ≥ 12 mmHg further amplified the risk, while CVP ≥ 14 mmHg was consistently associated with severe AKI and the need for RRT. The highest threshold (CVP ≥ 20 mmHg) showed the greatest risk escalation, linked to fluid overload, right heart failure, and mortality. Studies also suggest an optimal CVP range of 6–8 mmHg to minimize AKI incidence. Conclusions: Elevated CVP is an independent risk factor for the development of AKI in patients undergoing cardiac surgery. These findings suggest that CVP monitoring can play a significant role in predicting AKI and guiding perioperative management strategies.

Background/Objectives: This study aimed to investigate the hypothesis that an alveolar recruitment maneuver can restore lung compliance to initial values after laparoscopic gynecological surgery. Methods: A total of 31 patients who underwent laparoscopic gynecological surgery were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. An alveolar recruitment maneuver (incremental and decremental positive end-expiratory pressure) was applied ten minutes after the release of pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at eight different time points: after induction of anesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 min after insufflation of carbon dioxide (T4 and T5), in the supine position (T6), after desufflation (T7), and 10 min after an alveolar recruitment maneuver at the end of surgery (T8). Results: Pneumoperitoneum and the Trendelenburg position caused a decline of 15 units in compliance (T7 vs. T1; p < 0.05) compared to baseline. After the alveolar recruitment maneuver, compliance increased by 17.5% compared with the mean value of compliance at time T1 (T8 vs. T1; p < 0.05). The recruitment maneuver had favorable results in patients with low initial compliance (41.5 mL/cmH₂O, IQR: 9.75 mL/cmH₂O), high Body Mass Index 30.32 kg/m² (IQR: 1.05 kg/m²), and high initial plateau airway pressure (16.5 cmH₂O, IQR: 0.75 cmH₂O). Conclusions: Lung compliance does not return to initial values after performing laparoscopic gynecological procedures. However, after the release of pneumoperitoneum, an alveolar recruitment maneuver is beneficial as it improves compliance and gas exchange.

We report a case of a 35-year-old pregnant female of Afghan origin who was admitted to the intensive care unit (ICU) because of pulmonary edema development when she was in the 30th week of gestation. During the bedside examination, the transthoracic echocardiogram (TTE) revealed severe mitral valve stenosis and pulmonary hypertension. The patient went into treatment with metoprolol for the control of tachycardia and furosemide for the prevention of fluid overload. During the 32nd week of gestation, the medical council decided on a cesarean section (CS) to be carried out under general anesthesia. The anesthesiologists decided to use the Vigileo monitor (Edwards Lifesciences, Irvine, CA, USA) as it is vitally important to approach fluid administration as fluid management is challenging concerning the obstetric patient. Vigileo monitoring is based on the invasive measurement of cardiac output (CO), cardiac index (CI), stroke volume (SV), and stroke volume variation (SVV). Fluid resuscitation based on hemodynamic parameters is a key component of patient care, especially in scenarios such as cardiovascular disease. This is the first case report where a Vigileo monitor was applied to a patient with severe mitral valve stenosis and severe pulmonary hypertension undergoing a cesarean section, which was accomplished without any complications. The patient was discharged from the hospital on the 12th postoperative day, hemodynamically stable. Each immigrant woman, regardless of her financial, social, cultural, or any other situation, has the fundamental right to receive complete perinatal healthcare. Nevertheless, the most recent statistical data show that those women’s access to public healthcare is insufficient, leading to high rates of maternal mortality. The international medical community has to adapt to the new multicultural environment, and health services must be provided to this vulnerable population with the appropriate level of safety.