Automated systems for perioperative goal-directed hemodynamic therapy

AbstractPerioperative goal-directed hemodynamic therapy (GDHT) has evolved from invasive “supra-physiological” maximization of oxygen delivery to minimally or even noninvasively guided automated stroke volume optimization. Over the past four decades, investigators have simultaneously developed novel monitors, updated strategies, and automated technologies to improve GDHT. Decision s upport technology, which proposes an intervention based on the patient’s real time physiologic status, was an important step towards automation. Closed-loop systems have now been created to both increase GDHT compliance and decrease physician workload. These automated systems offer an elegant appr oach to optimize cardiac output and end-organ perfusion during the perioperative period. Most notably, automated preload optimization guided by dynamic indicators of fluid responsiveness has shown its feasibility, safety, and impact. Making the leap into fully automated GDHT has been accomplished on a small scale, but there are considerable challenges that must be surpassed before integrating all hemodynamic components into an automated system during general anesthesia. In this review, we will discuss the evolution and potential future of automated GDHT during the perioperative period.
Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research

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Purpose of review Stroke is the second leading cause of death and the third leading cause of disability worldwide. Treatment is time limited and delays cost lives. This review discusses modern stroke management, during a time when treatments and guidelines are rapidly evolving. Recent findings Stroke thrombectomy has become the therapy of choice for large vessel occlusion (LVO) strokes. Perfusion imaging techniques, both computed tomography (CT) and MRI, now allow treatment beyond a set time window in specific patients. Both general anaesthesia and conscious sedation are options for patients undergoing stroke thrombec...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
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Source: Anesthesiology - Category: Anesthesiology Source Type: research
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Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research
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Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
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Source: Neurocritical Care - Category: Neurology Source Type: research
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Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
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Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
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Source: Frontiers in Physiology - Category: Physiology Source Type: research
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Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refracto...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
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