Introduction. Uncertainty about approaches to optimizing monitoring and tactics of hemodynamic correction today directly affects the effectiveness of interventions. This problem is especially pronounced in the case of patients with high cardiac risk, as well as in the case of rapidly developing intraoperative hemodynamic disorders, which are a specific feature of some cardiac surgical interventions, such as myocardial revascularization operations on a beating heart. In such a situation, the key factor for the success of the operation is the coordination of the work of the surgeon and the anesthesiologist. Objectives. To determine the main approaches to monitoring and assessing the volemic status of a patient during direct myocardial revascularization operations on a working heart and to evaluate the possibility of transesophageal echocardiography as such a monitoring tool. Materials and methods. The search was carried out in the electronic databases PubMed, Scopus, Web of Science Core Collection; the analysis was carried out based on works published in the period from 2001 to 2021. Results. The resulting material, which includes validated peer-reviewed studies, randomized clinical trials, major systematic reviews and meta-analyzes, provides an overview of global experience in optimizing fluid loading and its characteristics in cardiac surgery patients. According to the analyzed data, there is no consensus among specialists on the above issues, and many important factors remain outside the framework of everyday clinical practice. For high-quality interaction, a combination of highly informative monitoring and proven tactics of conducting perioperative infusion therapy in response to the dynamically changing condition of the patient is required. Conclusions. To develop unified criteria for hemodynamic correction in each individual situation, it is necessary to assess the volemic status in patients who undergo myocardial revascularization on a beating heart in real time. In this vein, transpesophageal echocardiography is presented by the authors as the tool of choice for optimizing monitoring during off-pump coronary artery bypass graft surgery.
INTRODUCTION. The need for accurate risk stratification is obvious. Modern methods are quite cumbersome, which can cause difficulties when applied in routine practice, and therefore relatively simple but accurate forecasting methods have become very popular, which, however, have not been validated in Russia: SORT (Surgical Outcome Risk Tool), SRS (Surgical Risk Scale), POSPOM (Preoperative Score to Predict Postoperative Mortality), NZRISK (New Zealand RISK), SMPM (Surgical Mortality Probability Model). OBJECTIVES. The aim of this work is to determine the prognostic value of risk assessment scales in predicting an unfavorable postoperative outcome based on the analysis of data obtained in the STOPRISK study in patients undergoing open abdominal surgery. MATERIALS AND METHODS. The analysis of data on perioperative parameters of 1,179 patients who underwent open abdominal surgery is presented. RESULTS. The fatal outcome was recorded in 14 patients (1.18 %). A total of 135 complications were registered in 92 patients (7.8 %). All scales demonstrated satisfactory prognostic value in assessing the risk of complications (the area under the operating characteristic curve (AUROC) for the Physical Status Scale of the American Society of Anesthesiologists (ASA) was 0.714 (0.687-0.739), for the Surgical Risk Scale (SRS) - 0.727 (0.701-0.753), for the Surgical Outcome Risk Scale (SORT) - 0.738 (0.712-0.763), for the New Zealand Risk Scale (NZRISK) - 0.763 (0.738-0.787)), for the Surgical Mortality Probability Scale (SMPM) - 0.732 (0.706-0.757), for the Preoperative Postoperative mortality Prediction Scale (POSPOM) - 0.764 (0.738-0.788)) and good in assessing the risk of death (AUROC for the ASA scale was 0.82 (0.804-0.843), for the SRS scale - 0.860 (0.838-0.879), for the SORT scale - 0.860 (0.838-0.879), for the NZRISK scale - 0.807 (0.783-0.829), for the SMPM scale - 0.852 (0.831-0.872), for the POSPOM scale - 0.811 (0.788-0.833)). CONCLUSIONS. All the studied scales have good prognostic value in assessing the risk of 30-day mortality after major abdominal surgery. The NZRISK and POSPOM scales demonstrate good prognostic value for cardiovascular complications, POSPOM and SRS scales - for acute renal injury. POSPOM and NZRISK scales showed an excellent prognostic value in relation to the risk of postoperative delirium.
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