Perioperative haemodynamic optimisation

Edwards, Mark R. and Pearse, Rupert M. (2019) Perioperative haemodynamic optimisation. In, Pinsky, Michael R., Teboul, Jean-Louis and Vincent, Jean-Louis (eds.) Hemodynamic Monitoring. (Lessons from the ICU) Cham. Springer Cham, pp. 457-467. (doi:10.1007/978-3-319-69269-2_36).

Abstract

The use of fluid and inotropic therapies to optimise global haemodynamic variables, in particular oxygen delivery, in critically ill patients has been a controversial area of research for more than 25 years. The aim of this review is to describe the current evidence base for this treatment and how concepts of haemodynamic optimisation have evolved in recent years. The inconsistent findings of a large number of small phase II trials continue to stimulate the debate about the value of this treatment approach. However, important recent developments include the use of optimisation only during periods of resuscitation, more cautious doses of fluid and/or inotropic therapy, confirmation that pulmonary artery catheter use does not result in excess mortality and an improved understanding of the mechanistic effects of haemodynamic optimisation. These advances in our understanding have now informed the design of large randomised trials in various patient groups. The true value of haemodynamic optimisation is likely to be confirmed or refuted within the next 5 years.

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