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Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper
Despite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answe...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046882/ https://www.ncbi.nlm.nih.gov/pubmed/33852124 http://dx.doi.org/10.1186/s13613-021-00845-1 |
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author | Fellahi, Jean-Luc Futier, Emmanuel Vaisse, Camille Collange, Olivier Huet, Olivier Loriau, Jerôme Gayat, Etienne Tavernier, Benoit Biais, Matthieu Asehnoune, Karim Cholley, Bernard Longrois, Dan |
author_facet | Fellahi, Jean-Luc Futier, Emmanuel Vaisse, Camille Collange, Olivier Huet, Olivier Loriau, Jerôme Gayat, Etienne Tavernier, Benoit Biais, Matthieu Asehnoune, Karim Cholley, Bernard Longrois, Dan |
author_sort | Fellahi, Jean-Luc |
collection | PubMed |
description | Despite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a “validity criteria checklist” before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients. |
format | Online Article Text |
id | pubmed-8046882 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-80468822021-04-30 Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper Fellahi, Jean-Luc Futier, Emmanuel Vaisse, Camille Collange, Olivier Huet, Olivier Loriau, Jerôme Gayat, Etienne Tavernier, Benoit Biais, Matthieu Asehnoune, Karim Cholley, Bernard Longrois, Dan Ann Intensive Care Review Despite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a “validity criteria checklist” before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients. Springer International Publishing 2021-04-14 /pmc/articles/PMC8046882/ /pubmed/33852124 http://dx.doi.org/10.1186/s13613-021-00845-1 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Review Fellahi, Jean-Luc Futier, Emmanuel Vaisse, Camille Collange, Olivier Huet, Olivier Loriau, Jerôme Gayat, Etienne Tavernier, Benoit Biais, Matthieu Asehnoune, Karim Cholley, Bernard Longrois, Dan Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper |
title | Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper |
title_full | Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper |
title_fullStr | Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper |
title_full_unstemmed | Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper |
title_short | Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper |
title_sort | perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046882/ https://www.ncbi.nlm.nih.gov/pubmed/33852124 http://dx.doi.org/10.1186/s13613-021-00845-1 |
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