Best practice & research. Clinical anaesthesiology
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It is often unclear whether or not a patient's stroke volume will increase following a fluid bolus. Volume responsiveness is defined by an increase in stroke volume following a fluid bolus. ⋯ However, lung-protective ventilation is increasingly being used to avoid the adverse outcomes of higher tidal volume ventilation, and pulse pressure and stroke volume variation do not effectively predict volume responsiveness in the setting of lung-protective ventilation without using special techniques. Dynamic preload assessment is more effective at determining whether a patient will be fluid responsive than static measures of preload, but further studies are needed to more conclusively show that outcomes are improved with this approach to fluid management.
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Best Pract Res Clin Anaesthesiol · Dec 2014
ReviewOesophageal Doppler cardiac output monitoring: a longstanding tool with evolving indications and applications.
Much work has been done over the years to assess cardiac output and better grasp haemodynamic profiles of patients in critical care and during major surgery. Pulmonary artery catheterization has long been considered as the standard of care, especially in critical care environments, however this dogma has been challenged over the last 10-15 years. This has led to a greater focus on alternate, lesser invasive technologies. ⋯ The science underpinning Doppler shift assessment of velocity stretches back over 100 years, whereas the clinical applicability, and specifically clinical outcomes improvement can be attributed to the last 20 years. Oesophageal Doppler monitoring (ODM), and its associated protocol-guided fluid administration, has been shown to reduce complications, length of stay, and overall healthcare cost when incorporated into perioperative fluid management algorithms. However, more recent advances in enhanced recovery after surgery programs have led to similar improvements, leading the clinician to consider the role of Oesophageal Doppler Monitor to be more focused in high-risk surgery and/or the high-risk patient.
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Best Pract Res Clin Anaesthesiol · Dec 2014
ReviewHemodynamic monitoring devices: putting it all together.
Perioperative hemodynamic optimization of the high-risk surgical patient is associated with reduced postoperative morbidity and mortality. The hemodynamic parameters to be optimized (using goal-directed algorithms) encompass preload, contractility, afterload, volume responsiveness, and end-organ perfusion. Current hemodynamic monitors facilitate multi-modal monitoring of these macro-hemodynamic targets. This review focuses on the variety of invasive, minimally invasive, and noninvasive hemodynamic monitors available to the clinician.
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Best Pract Res Clin Anaesthesiol · Dec 2014
ReviewPrinciples of pharmacologic hemodynamic management and closed-loop systems.
Every day, physicians in critical-care settings are challenged with the hemodynamic management of patients with severe cardiovascular derangements. There is a potential role for closed-loop (automated) systems to assist clinicians in managing these patients and growing interest in the possible applications. In this review, we discuss the basic principles of critical-care hemodynamic management and the closed-loop systems that have been developed to help in this setting.
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Echocardiography has become an indispensable tool in the evaluation of medical and surgical patients. As ultrasound (US) machines have become more widely available and significantly more compact, there has been an exponential growth in the use of transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE) and other devices in the perioperative setting. Here, we review recent findings relevant to the use of perioperative US, with a special focus on the haemodynamic management of the surgical patient.