Perioperative Hemodynamic Management 4.0

Publication date: Available online 24 April 2019Source: Best Practice & Research Clinical AnaesthesiologyAuthor(s): Frederic Michard, Matthieu Biais, Suzana M. Lobo, Emmanuel FutierSummaryPostoperative complications within 30 days represent the third leading cause of death in the world. Multiple solutions have been proposed to tackle the clinical and economic burden of postoperative complications. They include the optimal fluid and hemodynamic management of patients undergoing major surgery. A better understanding of cardiovascular physiology and technological improvements are responsible for the evolution of perioperative hemodynamic management from the mere normalization of heart rate, blood pressure and central venous pressure, to oxygen delivery maximization with a pulmonary artery catheter, and individualized fluid management with esophageal Doppler or pulse contour methods. The concept of personalized management recently emerged and may soon become a reality, thanks to new technologies enabling non-invasive measurement of cardiac output, not only during and after, but also before surgery. The monitoring of micro-circulation and tissue perfusion may help to fine tune this approach. Importantly, mortality in the 30 days after surgery is 1000 times higher than intraoperative mortality. Therefore, continuous ward monitoring with wireless and wearable sensors may be the next major opportunity to improve patient safety.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research