Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

There were 2 out of 3 experts who were familiar with or had used this technology before.

Level of innovation

Two experts thought that the Acumen hypotension prediction index (HPI) technology is innovative because it uses machine learning. All experts stated that this device could mean that hypotension can be predicted and could allow for preventative treatment. However, one expert stated that it is unknown if actions on the alert will affect patient outcomes. All experts stated that this device would be used in addition to standard care. One expert further stated that the device needs to show that it increases safety before it is widely used.

Potential patient impact

Two experts stated that this device would be used for those at moderate-to-high risk when having major surgery. One expert further included those having high-risk surgery, those admitted to intensive care and those who are critically ill, including pre-hospital care and emergency room settings. One expert also included any person in intensive care with an invasive arterial line for a haemodynamic purpose. One expert stated that the benefit of the technology is the reduction in hypotension. However, they stated that this would only be beneficial if the cause of the hypotension is addressed. They also expressed uncertainties around whether a reduction in hypotension translates into improved patient outcomes. One expert stated that the potential benefits would depend on whether the device affects clinical behaviour and whether there are unexpected consequences of taking preventative measures. One expert stated that the technology could lead to improved outcomes, fewer hospital visits, fewer long-term complications, more appropriate use of existing resources and shorter lengths of stay.

Potential system impact

Two experts stated that there would be high equipment costs, which could be greater than standard care. One expert felt that the capital costs and the cost of the transducers is greater than the potential costs saved. This is because the evidence on outcome benefits is not proven. However, another expert felt that fewer complications, reduced length of stay (resulting in an increase in surgery capacity) and better allocation of post-operative high-care beds would lead to cost savings. One expert said that it will be difficult to show cost savings because the targeted measure is only one of the factors influencing cost. They also added that there could be additional costs associated with additional interventions triggered by device use. All experts stated that training would be needed to use the device. One expert further stated that there is a need for training on understanding the additional parameters displayed by the monitor.

General comments

One expert stated that there is a theoretical potential to overtreat hypotension because there is a false positive rate with the technology, but this is unlikely to have a clinical impact. Another expert also stated that caution is needed in using the HPI value as a physiological variable, rather than a predictive index. This could lead to inappropriate treatment being given and could cause unintended harm. One expert felt that the studies were more proof of concept and that separate evidence and consideration is needed for perioperative and intensive care management. One expert thought that there were uncertainties about whether actions taken because of using the technology would improve outcomes and whether the device was capable at reacting to extremes of physiology.