Perioperative Haemodynamic Optimisation

Aya, Hollmann D.; Cecconi, Maurizio; Rhodes, Andrew

doi:10.5152/tjar.2014.2220141

Cited by 4 publications

(5 citation statements)

References 108 publications

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“…Despite the higher cardiac output, other research studies demonstrated that elevating MAP with noradrenaline above 65 mmHg on balance was not linked to better organ perfusion. In these studies, however, an increase in cardiac output following the first MAP escalation step from 65 to 75 mmHg was not clinically significant (>10%), and additional MAP increases in those studies did not appreciably increase the cardiac output (5,10).…”

Section: Mean Arterial Pressure (Map)mentioning

confidence: 71%

“…Only 10-15% of surgical procedures are performed on high-risk patients, yet they are responsible for more than 80% of deaths. Patients who are admitted to the intensive care unit after receiving initial postoperative treatment in a normal ward have the highest mortality rates of almost 39% in this demographic (5). Perioperative haemodynamic strategies are also referred to as goal-directed therapy (GDT) and have been designed in an effort to reduce morbidity and mortality among patients.…”

Section: Discussionmentioning

confidence: 99%

“…In recent times, clinical research has supported the beneficial effects of perioperative hemodynamic optimization on surgical mortality and postoperative complication rates. In order to direct therapies to meet predetermined goals, this approach necessitates the use of advanced hemodynamic monitoring (5).…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Haemodynamic Optimization Strategies in HighRisk Surgical Patients

Nassar,

Almohisin,

Alnasser

et al. 2023

JOHS

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Millions of surgical procedures are performed globally each year. High-risk surgical procedures have varying but generally, high mortality and morbidity rates, making them a global challenge. In order to lower the risk of postoperative morbidity and mortality, perioperative haemodynamic optimization strategies have been designed. They are also referred to as goal-directed therapy. These guidelines for managing high-risk surgical patients propose strict adherence to values of mean arterial pressure not to fall below 65 mmHg during surgery, as mean arterial pressure significantly influences organ perfusion. It is recommended to utilize dynamic indicators to guide fluid administration in a substantial portion of non-cardiac surgery cases. However, it is advised to implement a checklist of validity criteria prior to administering volume expansion, acknowledging the recognized limitations of these indices. To tailor fluid therapy appropriately for individual patients and prevent fluid overload, it is commonly recommended to employ minimally invasive or non-invasive monitoring of stroke volume/cardiac output, particularly for patients undergoing moderate- to high-risk surgeries. Furthermore, these strategies suggest combining fluid administration with vasoconstrictors to sustain optimal blood flow and maintain perfusion pressure above hazardous thresholds. Incorporating personalized hemodynamic optimization approaches to reduce postoperative complications, shorten hospital stays, and ultimately prevent mortality in high-risk surgical patients has become a crucial aspect of standard surgical care. This review aims to assess strategies for optimizing perioperative hemodynamics in high-risk surgical patients.

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Section: Mean Arterial Pressure (Map)mentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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Perioperative Haemodynamic Optimization Strategies in HighRisk Surgical Patients

Nassar,

Almohisin,

Alnasser

et al. 2023

JOHS

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“…The findings from our study resonate with the conclusions of previous research which underscore the crucial role of nursing interventions in optimizing postoperative care outcomes. 13 One study 14 found that patients who received additional nursing care reported better management of symptoms and lower rates of postoperative complications compared to those receiving standard care alone. The objective of the study was to investigate the influence of comprehensive high-quality nursing care on postoperative complications, the degree of pain, and nursing satisfaction in these patients during the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Nursing Interventions on the Treatment Outcomes of Renal Cell Carcinoma with Postoperative Interleukin-2 and Recombinant Human Interferon

Guo,

Zhao,

Chen

et al. 2024

JMDH

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Objective This study investigates the impact of nursing interventions on treatment outcomes and adverse reaction rates in renal cell carcinoma (RCC) patients treated postoperatively with Interleukin-2 and recombinant human Interferon. Methods In a retrospective analysis of 90 RCC patients, 43 received standard care (control group), while 47 received additional nursing interventions (intervention group), including psychological care, vital signs monitoring, dietary care, adverse reaction management, and post-discharge care. Patients with concurrent major diseases or other malignancies were excluded. Key assessments included clinical symptom improvement, treatment efficacy, and postoperative adverse reactions. Results Among the 90 participants, no significant demographic differences were found between the two groups. The intervention group showed significant improvements in fever resolution, leukocyte normalization, and shorter hospital stays. The overall treatment effectiveness was similar in both groups (90.7% in the intervention group vs 91.5% in the control group). However, the intervention group experienced significantly fewer postoperative adverse reactions, including fever, gastrointestinal symptoms, bone marrow suppression, and neurological abnormalities (6.3% vs 23.2%). Conclusion The study suggests that nursing interventions can improve treatment outcomes by reducing postoperative adverse reactions in RCC patients receiving postoperative Interleukin-2 and recombinant human Interferon. The overall effectiveness of treatment and care was comparable between the groups. Further extensive studies are needed to confirm these findings and fully understand the impact of nursing interventions on RCC patient outcomes.

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“…Given the incidence of high morbidity and mortality rates in high-risk surgery patients, ensuring stable and sufficient cardiac output (CO) or cardiac index (CI) is crucial for patients' survival (1)(2)(3). The National Institute for Health and Clinical Excellence (NICE) 2011 has recommended CO monitoring to ensure that perioperative goaldirected therapy optimization correlates with improved postoperative outcomes in moderate-to high-risk surgery patients (4,5). Kidney transplant surgery requires monitoring because of comorbidities, graft staging, renal vessel anastomosis, and ischemia-reperfusion.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Bioimpedance Versus Pulse Contour Analysis for Intraoperative Cardiac Index Monitoring in Patients Undergoing Kidney Transplantation

2021

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Background: Cardiac index (CI; cardiac output indexed to body surface area) is routinely measured during kidney transplant surgery. Bioimpedance cardiometry is a transthoracic impedance as the non-invasive alternative for hemodynamic monitoring, using semi-invasive uncalibrated pulse wave or contour (UPC) analysis. Objectives: We performed a cross-sectional observational study on 50 kidney transplant patients to compare the CI measurement agreement, concordance rate, and trending ability between bioimpedance and UPC analysis. Methods: For each patient, CI was measured by bioimpedance analysis (ICONTM) and UPC analysis (EV1000TM) devices at three time points: after induction, during incision, and at reperfusion. The device measurement accuracy was assessed by the bias value, limit of agreement (LoA), and percentage error (PE) using Bland-Altman analyses. Trending ability was assessed by angular bias and polar concordance through four-quadrant and polar plot analyses. Results: From each time point and pooled measurement, the correlation coefficients were 0.267, 0.327, 0.321, and 0.348. Bland-Altman analyses showed mean bias values of 1.18, 1.06, 1.48, and 1.30, LoA of -1.35 to 3.72, -1.39 to 3.51, -1.07 to 4.04, and -1.17 to 3.78, and PE of 82.21, 78.50, 68.74, and 74.58%, respectively. Polar plot analyses revealed angular bias values of -10.37º, -15.01º, -18.68º, and -12.62º, with radial LoA of 89.79º, 85.86º, 83.38º, and 87.82º, respectively. The four-quadrant plot concordance rates were 70.77, 67.35, 65.90, and 69.79%. These analyses showed poor agreement, weak concordance, and low trending ability of bioimpedance cardiometry to UPC analysis. Conclusions: Bioimpedance and UPC analysis for CI measurements were not interchangeable in patients undergoing kidney transplant surgery. Cardiac index monitoring using bioimpedance cardiometry during kidney transplantation should be interpreted cautiously because it showed poor reliability due to low accuracy, precision, and trending ability for CI measurement.

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Perioperative Haemodynamic Optimisation

Cited by 4 publications

References 108 publications

Perioperative Haemodynamic Optimization Strategies in HighRisk Surgical Patients

Perioperative Haemodynamic Optimization Strategies in HighRisk Surgical Patients

The Impact of Nursing Interventions on the Treatment Outcomes of Renal Cell Carcinoma with Postoperative Interleukin-2 and Recombinant Human Interferon

Comparison of Bioimpedance Versus Pulse Contour Analysis for Intraoperative Cardiac Index Monitoring in Patients Undergoing Kidney Transplantation

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