Importance of arterial measurement sites for intraoperative hemodynamic management during major abdominal surgeries: The IPAMS randomized trial protocol
Bibliographic record
Abstract
Abstract Introduction Reliable hemodynamic parameters are crucial to prevent perioperative hypotension, one of the most significant modifiable risk factors for postoperative morbidity and mortality. The current standard of care for intraoperative hemodynamic monitoring is achieved through an arterial radial catheter, but its reliability has been increasingly questioned due to the incidence of a phenomenon called the radial-to-central arterial pressure gradient. Studies have shown that this gradient occurs in one-third of cardiac surgery patients predominantly during moments of hemodynamic instability, when accurate blood pressure monitoring is critical. However, it remains unclear whether and how this phenomenon affects non-cardiac surgical populations. Objectives The main objective is to study whether brachial arterial pressure monitoring reduces intraoperative vasopressor dosage compared to conventional radial monitoring. We hypothesized that patients undergoing major abdominal surgery with brachial arterial pressure monitoring will require lower time-weighted average of phenylephrine administration compared to those monitored with radial arterial pressure. Our secondary objectives are to systematically describe the incidence of radial-to-brachial pressure gradients and identify predictive factors associated with this phenomenon. Materials and methods This single center randomized clinical trial will enroll 200 adult patients between 18 and 90 years of age, undergoing major abdominal surgery. Besides standardized anesthesia management, all patients will receive radial and brachial blood pressure monitoring, but only one blinded catheter will guide intraoperative hemodynamic management. We will record radial and brachial arterial pressure curves, standard intraoperative data and post-operative complications. Ethics This trial has been approved by the regional ethics committee (Comité d’Éthique de la Recherche du CIUSSS de l’Est de l’Île de Montréal) Trial registration https://ClinicalTrials.gov (May 21st, 2025). Unique protocol ID: 2023-3299. Trial identification number: NCT06982001
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.013 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.023 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".