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Artificial intelligence-based predictive hemodynamic monitoring using the Hypotension Prediction Index (HPI), combined with goal-directed therapy (GDT), has been proposed to reduce IOH. However, its effectiveness in major maxillofacial and otolaryngologic surgery remains unclear.<\/jats:p>\n                    <jats:p>The purpose of the study was to assess whether HPI-guided management or classical GDT reduces IOH compared to standard care in patients undergoing major maxillofacial and otolaryngologic surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this randomized controlled pilot trial at a university hospital, 75 patients were allocated to one of three groups: control (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925), HPI-guided GDT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925), or classical GDT without HPI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925). In the control group, the advanced hemodynamic monitoring was blinded to the anesthesiologist. IOH was defined as mean arterial pressure (MAP)\u2009&lt;\u200965\u00a0mmHg for\u2009&gt;\u20091\u00a0min. Primary endpoints were the number and total duration of IOH episodes. Secondary endpoints included the time-weighted average MAP\u2009&lt;\u200965\u00a0mmHg (TWA65) and postoperative complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-four patients were analyzed. The HPI group showed significantly fewer IOH episodes (median 3.0 vs. 7.0;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and shorter IOH duration (7.0\u00a0min vs. 46.0\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) compared to control. No significant difference was observed between the classical GDT and control groups. Secondary outcomes were comparable across all groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HPI-guided hemodynamic management significantly reduces the frequency and duration of IOH in major head and neck surgery. Larger studies are needed to evaluate effects on clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The trial was registered on clinicaltrials.gov (NCT04151264) on 14th October 2019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s44158-025-00331-1","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:31:22Z","timestamp":1766363482000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Artificial intelligence-based predictive hemodynamic monitoring in conjunction with goal-directed therapy reduces duration, frequency, and severity of intraoperative hypotension in major maxillofacial and otolaryngological surgery\u2014a prospective randomized controlled pilot trial"],"prefix":"10.1186","volume":"5","author":[{"given":"Amir","family":"Ali Akbari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Koch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6tz","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schmermund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Langer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Edinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Marie","family":"Denn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Markmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marit","family":"Habicher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"331_CR1","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1097\/ALN.0b013e3182a10e26","volume":"119","author":"M Walsh","year":"2013","unstructured":"Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN et al (2013) Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery. 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Ethics approval and consent to participate: Ethical approval was obtained from the institutional ethics committee (Justus Liebig University ethics committee, Chairperson Prof. Dr. H. Tillmanns) prior to the commencement of the study (Reference AZ170\/18) on the 31\u2009st of August 2018. Written informed consent was obtained from all participants at least 1\u00a0day before surgery by one member of the study team.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable (the manuscript contains no identifiable individual person\u2019s data, images, or videos).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MH has received honoraria for consulting and for giving lectures from Edwards Lifesciences (Irvine, CA, USA). MH has received honoraria for giving lectures from Baxter (Deerfield, IL, USA). AAA has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). MS is consultant for Edwards Lifesciences and has received institutional research funding for investigator-initiated trials and honoraria for giving lectures from Edwards Lifesciences. CK, GS, DS, CL, FE, SD and MM have no conflicts of interests relating to this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"92"}}