Acumen Hypotension Prediction Index software
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The Acumen Hypotension Prediction Index (HPI) software is a first-of-its-kind technology that provides you with information regarding the likelihood of a patient trending toward a hypotensive event*
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*A hypotensive event is defined as MAP <65 mmHg for a duration of at least one minute.
ForeSight tissue oximetry system
Absolute measures, comprehensive insights
Accounts for individual differences, including skin tone, size, age, scalp-cortex distance and acuity Delivers absolute StO values, making preinduction baselines optional Integrates with the HemoSphere platform for an all-in one view of patient perfusion
Discover the ForeSight system difference
Risks of cerebral desaturation
Absolute, actionable measures
All-in-one monitoring
The system
Designed for diversity
CAUTION: Federal (United States) law restricts this device to sale by or on the order of a physician. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions, and adverse events.
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Only ForeSight sensor:
Because the right monitoring makes a difference – for all your patients’ differences.
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Know the risks - and the solutions
Cerebral desaturations
Understand the risks
Learn how ForeSight system works
Cerebral tissue oxygen desaturations are common in cardiac surgical cases, and the risk – and impact – can extend into the the postoperative phase.
Incidence and impact of cerebral desaturations
Research has consistently shown that cerebral tissue oxygen desaturations are common across a broad spectrum of surgical procedures and patient populations – and that they can cause significant complications.
Visibility is the key to intervention
Cerebral and somatic tissue oximetry desaturations are common – but with ForeSight sensor connected to HemoSphere monitor, the tissue oximetry and advanced hemodynamic insights you need to identify and even reverse cerebral desaturations for a diverse patient population are available on one monitor.
Note: Each publication has an independent definition of desaturation including absolute vs. relative change, duration of time, oximeter used, etc. *Denotes incidence in prospective arm of publication **Denotes incidence in randomized arm of publication
How the ForeSight system works
Impact of cerebral desaturations among cardiac surgical patients
Preserve brain health: understand and intervene
Detecting, preventing and avoiding cerebral desaturations are critical in helping to assure patient brain health. While desaturations can lead to serious complications, the good news is that with the right interventions at the right time, they can be treated – and even reversed.
Yao et al.
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Murkin et al.
Schön et al.
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Deschamps et al.
Subramanian et al.
Uysal et al.
Greenberg et al.
5*
5**
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90%
56%
23.7%
48.8%
73%
57%
63.2%
61%
59%
Mean desaturation incidence across studies shown
Neurological
Length of Stay
Greenbergb et al.
ForeSight sensor delivers absolute StO values that – when used in combination with the full hemodynamic insights delivered by the HemoSphere advanced monitoring platform – enable you to confidently recognize and reverse cerebral desaturations.
Absolute measures, actionable insights
Learn more about the ForeSight system
Preinduction baseline optional
Manage variability in volume administration
Advanced hemodynamic parameters provided by the Acumen IQ sensor may be used in perioperative goal-directed therapy (PGDT) protocols
PGDT is a treatment protocol using dynamic, flow-based parameters with the objective of making the appropriate volume management decisions. PGDT can be implemented in a single procedure or as part of a larger initiative such as Enhanced Recovery After Surgery pathways.
Acumen HPI software combined with a treatment protocol achieved statistically significant reduction in hypotension vs. standard of care
Two randomized controlled trials have shown that using Acumen HPI software in combination with a hemodynamic treatment protocol significantly reduced the incidence and duration of hypotensive events in patients undergoing noncardiac surgery.
Reference: 1. Cannesson, M. (2010) Arterial pressure variation and goal-directed fluid therapy. Journal of Cardiothoracic and Vascular Anesthesia, 24(3), 487-97.
Cerebral oximetry calibrated and validated to SjvO Somatic oximetry calibrated and validated to ScvO
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Giving you the insights to protect
ForeSight sensor provides continuous, absolute StO readings without the need for a preinduction baseline – while still giving you the freedom to set treatment thresholds and trend from a patient baseline.
ForeSight sensor algorithms are calibrated and validated to both cerebral and somatic regions:
Algorithms tailored to placement on body
Because ForeSight sensor integrates with the HemoSphere advanced monitoring platform, you get more than numbers – you get comprehensive insights into patient perfusion, as well as the ability to see the root cause of imbalances.
Actionable insights
Learn more about ForeSight sensor
Due to the limitations in some other tissue oximetry system designs, patient differences including melanin or bilirubin concentrations, cranial thickness, etc. can cloud the accuracy – and therefore the reliability – of oxygenation measures.
The right monitoring makes a difference –for all your patients’ differences
Start improving how you detect hypotensive events
Multiple studies have shown that Acumen HPI software:
Achieves statistically significant reduction of hypotension when combined with a treatment protocol in noncardiac surgery vs. standard of care Demonstrates superior predictive abilities for hypotension than common hemodynamic parameters such as cardiac output (CO), stroke volume (SV), and changes in mean arterial pressure (MAP) Has proven and reliable accuracy
See the study
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The HPI high alert popup alerts you when your patient is trending toward or experiencing a hypotensive event.* If the HPI parameter value exceeds 85 for two consecutive 20-second updates or reaches 100 at any time, the HPI high alert popup window will appear, prompting you to review the patient hemodynamics using the HPI secondary screen.
HPI high alert popup
The advanced hemodynamic pressure and flow parameters provided on the HPI secondary screen allow you to investigate and identify the root cause of potentially developing hypotensive events.
HPI secondary screen
The HPI parameter value is updated every 20 seconds, providing continuous predictive insights into developing hypotensive events.*
Educational resources
Case study: Clinical utility of dP/dt
Hypotension Prediction Index (HPI) Parameter
In conventional two-wavelength tissue oximetry systems, skin pigmentation has been shown to interfere with the clinical measurement of regional cerebral oxygen saturation. (Sun et al. )
The advanced hemodynamic parameters on the secondary screen are arranged visually by:
Preload Contractility Afterload
Preload
Stroke volume variation (SVV) or Pulse pressure variation (PPV) The percent difference between minimum and maximum stroke volume (SV) or pulse pressure (PP) during a respiratory cycle It may be used as an indicator of fluid responsiveness.
Contractility
Systolic slope (dP/dt) Maximum upslope of the arterial pressure waveform from a peripheral artery. It measures the maximum rate of the arterial pressure rise during left ventricular contraction Changes from baseline or trend values of arterial dP/dt are more useful than absolute values, and may be an indicator of increasing or decreasing contractility
Afterload
Dynamic arterial elastance (Ea ) The ratio of pulse pressure variation to stroke volume variation It may be used as a predictor to determine when a preload responsive patient may also be pressure responsive. Ea greater than 1.0 may suggest that preload responsive patients will increase their mean arterial pressure in response to a fluid bolus
dyn
ForeSight sensor is designed to penetrate deeper. At 2.5 cm, ForeSight sensor can provide reliable readings for patients with a scalp-to-cortex distance of 2 cm or greater.
Designed to penetrate 25% deeper than other technologies
Ea explained
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Created with patient differences in mind
ForeSight sensor has been demonstrated to accommodate for the melanin present in a patient’s skin because of its fifth wavelength of near infrared light (NIRS). (Stannard et al. )
Discover all-in-one insights
With a unique sensor design and exclusive fifth wavelength of near infrared light (NIRS), ForeSight sensor can account for these patient differences – enabling reliable StO measures from patient to patient.
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Studies show ForeSight sensor accounts for individual differences in melanin
With HemoSphere advanced monitoring platform
One monitor, comprehensive insights
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Acumen IQ sensor
Features
Model Numbers
Advanced hemodynamic parameters provided by the Acumen IQ sensor offer you continuous insight into your patient’s hemodynamic status.
Unlocks the Acumen Hypotension Prediction Index software. Connects to any existing radial arterial line. Automatically updates advanced parameters every 20 seconds, reflecting rapid physiological changes in moderate- to high-risk surgery.
AIQS8
84 in / 213 cm
Model
Description
Length
Unit of measure
Acumen IQ sensor standalone
Acumen IQ sensor standalone (5-pack)
60 in / 152 cm
EA
5
Acumen Analytics software
Acumen Analytics software enables you to analyze parameters from the EV1000 and HemoSphere monitoring platforms retrospectively, providing insights into hemodynamic management of individual patients, as well as groups of patients. The view of specific pressure and flow parameters allows you to analyze:
Hypotension frequency Hypotension duration Hypotension prevalence
More on HemoSphere advanced monitoring platform
HemoSphere advanced monitoring platform
HemoSphere advanced monitoring platform offers advanced hemodynamic parameters that can help guide you with proactive decision support in a range of clinical situations and settings so you can maintain optimal patient perfusion.
AIQS85
AIQS6
AIQS65
AIQS8C503
Acumen IQ sensor with TruWave disposable pressure transducer
AIQS6AZ
Acumen IQ sensor with VAMP adult system
AIQS6AZ5
AIQS6C502
Acumen IQ sensor with TruWave disposable pressure transducer with VAMP adult system
Acumen IQ cuff
AAcumen IQ cuff unlocks Acumen HPI software and provides continuous blood pressure and advanced hemodynamic parameters from a noninvasive finger cuff. Continuous data offered by the Acumen IQ cuff enables you to proactively optimize perfusion through hemodynamic management and provides more accurate systolic, diastolic and MAP values than a brachial cuff.
Unlocks the Acumen Hypotension Prediction Index software. Gives you noninvasive access to automatically calculate beat-to-beat hemodynamic information for a broad patient population, including patients in who an arterial line would not be typically placed. The easy to use self-coiling mechanism within the interior of the cuff wraps snugly around the patient’s finger and offers improved cuff placement, consistent snugness, and usability.
AIQCM
Medium
AIQCS
Small
Pack size
AIQCL
Large
Tissue oximetry measures are only one part of a surgical patient’s hemodynamic profile. That’s why ForeSight sensor is available as part of HemoSphere advanced monitoring platform, the only system that allows you to see a comprehensive view of patient perfusion on one monitor.
This “all-in-one” view delivers comprehensive insights into patient perfusion that can help you drill down to identify the root cause of imbalances – enabling you to administer interventions with confidence.
Identify the root cause of events
Another parameter available on HemoSphere platform is Hypotension Prediction Index (HPI), available through Acumen HPI software. This first-of-its kind of predictive software that alerts you to the likelihood of a patient trending toward hypotension – may help you to prevent or mitigate cerebral desaturations caused by hypotension.
Predict hypotension
In addition to saving limited space in your OR, integrating tissue oximetry and hemodynamics into a single monitor eliminates the need to manually process and integrate your pressure, flow, and tissue oximetry measures.
Access integrated insights
Learn more about the clinical considerations and physiology of cerebral desaturation
Download reference
See references
ForeSight system is available as part of HemoSphere advanced monitoring platform – making it the only system that allows you to see a comprehensive view of patient perfusion (including pressure, flow, and tissue oximetry) on one monitor.
Publication in JAMA: “Effect of a Machine Learning–Derived Early Warning System for Intraoperative Hypotension vs Standard Care on Depth and Duration of Intraoperative Hypotension During Elective Noncardiac Surgery: The HYPE Randomized Clinical Trial”
HYPE trial results featured in JAMA
Elective, noncardiac surgery patients monitored with Acumen HPI software had a median time of hypotension per patient of 8 minutes compared to 32.7 minutes in the control group. Time-weighted average of hypotension combines the duration and the severity of hypotension corrected for the total duration of the procedure. With Acumen HPI software, the study showed a median .38 mmHg difference between the interventional and control group. The Acumen HPI software secondary screen provided insight into the potential root cause of that hypotension, enabling clinicians to identify the appropriate treatment course.
Publication in the Journal of Clinical Monitoring and Computing: “Hypotension Prediction Index based protocolized haemodynamic management reduces the incidence and duration of intraoperative hypotension in primary total hip arthroplasty: a single centre feasibility randomised blinded prospective interventional trial”
Results from Acumen HPI implementation in total hip arthroplasty prospective trial
Number of hypotensive events per hour (n/hr) Absolute IOH time (sec) Relative IOH time (IOH time as % of total anesthesia time)
Acumen Hypotension Prediction Index software combined with protocolized treatment was shown to reduce the relative and absolute duration of hypotensive events in total hip arthroplasty patients, in comparison to a historical and prospective control group.
HPI
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HPI=Hypotension Prediction Index software; CTRL=routine anaesthetic care cohort; hCTRL=historic control group HPI group, n=25; CTRL, n=24; hCTRL, n=50. Total n=99
Prediction of hypotension at 5 minutes before an event
Publication in Anesthesia and Analgesia: “Ability of an Arterial Waveform Analysis–Derived Hypotension Prediction Index to Predict Future Hypotensive Events in Surgical Patients” When compared with hemodynamic parameters such as SV, CO, SVV, and MAP, Acumen HPI software showed a higher predictive performance at 5 and 10 minutes before hypotension in this study.
Acumen HPI software had superior ability to predict hypotensive events than common hemodynamic parameters
Receiver operating characteristic curves for HPI, CO, SV, MAP, PP, HR, SVV, and shock index for prediction hypotension 5 and 10 min before the event.
Publication in Anesthesiology: “Machine-learning Algorithm to Predict Hypotension Based on High-fidelity Arterial Pressure Waveform Analysis”
Acumen HPI software demonstrated high accuracy in predicting hypotension
Predictive algorithms can be assessed via a ROC curve, with the AUC showing the predictive power of the algorithm for a specific dataset. At 10 minutes before an event, Acumen HPI software predicted hypotension with a specificity and sensitivity of 89% and 90% respectively, and with an AUC of 0.95 in this study.
AUC=area under curve; ROC=receiver operating characteristic.
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Highlights from 2020 Wijnberge, et al.
Highlights from 2019 Schneck, et al.
Highlights from 2019 Davies, et al.
Highlights from Hatib, et al
Prediction of hypotension at 10 minutes before an event
ROC closest to the y-axis approaches a perfect model, with fewer false-positive and false-negative values
Hypotension was defined as a MAP <65 mmHg for at least 1 minute.
Acumen Hypotension Prediction Index (HPI) software
Unlocked by Acumen IQ cuff or Acumen IQ sensor, Acumen HPI software is a first-of-its-kind technology that provides you with information regarding the likelihood of a patient trending toward hypotension.
The only modular hemodynamic monitoring platform to offer full-range cuff, sensor and catheter compatibility and first-of-its-kind predictive decision support software, HemoSphere advanced monitoring platform enables proactive, individualized patient management.
Explore HemoSphere platform
Discover Acumen HPI software
Model number
FSESL
ForeSight Elite large sensor (≥40 kg), 20 sensors/box
For Pediatric sensor models, click here
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Edwards, Edwards Lifesciences, the stylized E logo, Acumen, Acumen HPI, Acumen IQ, ForeSight, ForeSight Elite, HemoSphere, HPI, and Hypotension Prediction Index are trademarks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners. © 2022 Edwards Lifesciences Corporation. All rights reserved. PP--US-6568 v1.0 Edwards Lifesciences • One Edwards Way, Irvine CA 92614 USA • edwards.com
Yao FSF, et al. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18(5):552-8. Murkin JM, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study.Anesth Analg. 2007;104(1):51-8. Schön J, et al. Cerebral oxygen saturation monitoring in on-pump cardiac surgery – A 1 year experience. Appl CardiopulmPathophysiol. 2009;13: 243-252. de Tournay-Jetté, et al. The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery. Cardiothorac Vasc Anesth. 2011;25(1):95-104. Deschamps A, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. J Cardiothorac Vasc Anesth.2013;27(6):1260-6. Greenberg SB, et al. Cerebral desaturation events in the intensive care unit following cardiac surgery. Crit Care. 2013;28:270-276 Deschamps A, et al. Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation during high-risk cardiac surgery: a randomized controlled feasibility trial. Anesthesiology. 2016;124(4):826-36. Subramanian B, et al. A multicenter pilot study assessing regional cerebral oxygen desaturation frequency during cardiopulmonary bypass and responsiveness to an intervention algorithm. Anesth Analg. 2016;122(6): 1786-93. Uysal S, et al. Optimizing cerebral oxygenation in cardiac surgery: A randomized controlled trial examining neurocognitive and perioperative outcomes. J Thorac Cardiovasc Surg. 2020;159(3):943-953. Sun X, et al. Skin pigmentation interferes with the clinical measurement of regional cerebral oxygen saturation. Br J Anaesth. 2015:Feb;114(2):276-80. doi: 10.1093/bja/aeu335. Epub 2014 Oct 27. (https://pubmed.ncbi.nlm.nih.gov/25348729/ ) Stannard B, et al. Regional cerebral oximetry is consistent across self-reported racial groups and predicts 30-day mortality in cardiac surgery: a retrospective analysis. J Clin Monit Comput. 2021:Apr;35(2):413-421. doi: 10.1007/s10877-020-00487-x. Epub 2020 Feb 21.(https://pubmed.ncbi.nlm.nih.gov/32086678/) Hong SW, et al. Prediction of cognitive dysfunction and patients’ outcome following valvular heart surgery and the role of cerebral oximetry. Eur J Cardiothorac Surg.2008;33(4):560-565.
