Title :

Perioperative hemodynamic optimization: from guidelines to implementation-an experts' opinion paper.

Author(s) :

Fellahi, J. L. [Auteur]
Futier, E. [Auteur]
Vaisse, C. [Auteur]
Collange, O. [Auteur]
Huet, O. [Auteur]
Loriau, J. [Auteur]
Gayat, E. [Auteur]
Tavernier, Benoit [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Biais, M. [Auteur]
Asehnoune, K. [Auteur]
Cholley, B. [Auteur]
Longrois, D. [Auteur]

Journal title :

Annals of Intensive Care

Abbreviated title :

Ann Intensive Care

Volume number :

11

Pages :

p. 1-10

Publication date :

2021

ISSN :

2110-5820

English keyword(s) :

Hemodynamic optimization
Blood pressure
Fluid responsiveness
Vasopressors
Perioperative morbidity
High-risk surgery
Health costs

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

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 ...
Show more >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.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CHU Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2023-11-15T06:53:24Z
2024-02-14T10:04:55Z