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The novel haemodynamic parameter hypotension prediction index (HPI) has shown good performance in predicting hypotension by analysing arterial pressure waveform in various types of surgery. HPI\u2010based haemodynamic protocols were able to reduce the duration and depth of hypotension. We will try to determine whether haemodynamic therapy based on HPI can improve postoperative flap perfusion and tissue oxygenation by improving intraoperative mean arterial pressure and reducing fluid infusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We present here a study protocol for a single centre, randomized, controlled trial (<jats:italic>n\u2009=<\/jats:italic>\u00a042) in maxillofacial patients undergoing free flap surgery. Patients will be randomized into an intervention or a control group. In the intervention, group haemodynamic optimization will be guided by machine learning algorithm and functional haemodynamic parameters presented by the HemoSphere platform (Edwards Lifesciences, Irvine, CA, USA), most importantly, HPI. Tissue oxygen saturation of the free flap will be monitored noninvasively by near\u2010infrared spectroscopy during the first 24\u2009h postoperatively. The primary outcome will be the average value of tissue oxygen saturation in the first 24\u2009h postoperatively.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.15942","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T06:59:16Z","timestamp":1698217156000},"page":"684-690","source":"Crossref","is-referenced-by-count":4,"title":["Effect of machine learning\u2010guided haemodynamic optimization on postoperative free flap perfusion in reconstructive maxillofacial surgery: A study protocol"],"prefix":"10.1111","volume":"90","author":[{"given":"Marko","family":"Pra\u017eetina","sequence":"first","affiliation":[{"name":"Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine University Hospital Dubrava  Zagreb Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrej","family":"\u0160ribar","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine University Hospital Dubrava  Zagreb Croatia"},{"name":"School of Dental Medicine Zagreb University  Zagreb Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irena","family":"Sokolovi\u0107 Jurinjak","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine University Hospital Dubrava  Zagreb Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelena","family":"Mato\u0161evi\u0107","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine University Hospital Dubrava  Zagreb Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3777-8153","authenticated-orcid":false,"given":"Jasminka","family":"Per\u0161ec","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine University Hospital Dubrava  Zagreb Croatia"},{"name":"School of Dental Medicine Zagreb University  Zagreb Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0145561320923835"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30677"},{"issue":"3","key":"e_1_2_8_4_1","first-page":"177","article-title":"The role of anaesthetic management in enhancing peripheral blood flow in patients undergoing free flap transfer","volume":"67","author":"Aps C","year":"1985","journal-title":"Ann R Coll Surg Engl"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13741\u2010022\u201000244\u20105"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S327311"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2021.1841"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.08.049"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2147\/IBPC.S45292"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2011.08.010"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000780"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2015.08.004"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002300"},{"key":"e_1_2_8_14_1","first-page":"1","article-title":"Improving global outcomes (KDIGO). 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