Current practice in hemodynamic monitoring and management in high-risk surgery patients: a national survey of Korean anesthesiologists

Kim, Sang-Hyun; Kim, Minjae; Lee, Joon-Ho; Cho, Sung-Hwan; Chae, Won Seok

doi:10.4097/kjae.2013.65.1.19

Cited by 12 publications

(7 citation statements)

References 28 publications

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“…Though this result agrees with that obtained in similar studies conducted among Korean, Chinese, American, and European anesthetists,[ 2 4 6 ] we observed a huge gap in the usage of these two monitoring devices in this survey. The reasons responsible for low application of the cardiac output monitoring in other studies include the fact that some believe that cardiac output maximization is unnecessary or may be harmful[ 7 8 ] and that the procedure is difficult to perform routinely in the busy operating room.…”

Section: Discussionsupporting

confidence: 92%

“…This “addiction” to CVP by many clinicians despite studies that have shown its inadequate predictability of fluid responsiveness[ 5 9 ] has been documented by many other authors. [ 2 4 6 ] This has been attributed to familiarity with traditional variables and unavailability of standard protocols for cardiac output optimization. [ 4 ] Considering available HM tools available in Nigeria, central venous monitoring appears to be an important tool and may represent the peak device for assessing fluid responsiveness among high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 4 6 ] This has been attributed to familiarity with traditional variables and unavailability of standard protocols for cardiac output optimization. [ 4 ] Considering available HM tools available in Nigeria, central venous monitoring appears to be an important tool and may represent the peak device for assessing fluid responsiveness among high-risk patients. More recent parameters such as pulse pressure variation and systolic pressure variation are said to provide more reliable information about fluid responsiveness[ 10 11 ] and can be employed readily.…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic monitoring in Nigerian patients undergoing high-risk surgery

Osinaike

2015

Indian Journal of Critical Care Medicine

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Background:Hemodynamic monitoring (HM) and optimization of cardiac output and parameters of dynamic fluid responsiveness is said to improve perioperative outcome in high-risk surgical patients (HRSP). There is insufficient data to determine the burden of care and HM practices in HRSP in Nigeria. Hence, the need to assess and document the current hemodynamic management practices of anesthetists in Nigeria regarding patients undergoing high-risk surgery.Methods:An electronic mail (E-mail) based survey was conducted among 180 consultant members of the Nigeria Society of Anaesthetists. The survey contained 24 questions that range from practice location, experience in the perioperative management of high-risk patients, expectations of care, to what is available to the anesthetists to provide such care. The survey was on for 3 months.Results:A total of 157 E-mail messages were delivered, and 73 responses were received, giving a response rate of 46.5%. The survey showed that 67 (91.8%) of respondents provide or directly supervise anesthesia for HRSP, 50 (84%) of them do this 1–5 times a week. Noninvasive blood pressure (83.6%) was routinely monitored while the central venous pressure (CVP 35.6%), invasive blood pressure (28.8%), and cardiac output (1.4%) monitored less often. Urine output, arterial blood pressure, pulse rate, and clinical experience were considered best indicators of volume expansion. Most respondents were of the opinion that oxygen delivery to tissues is of major importance during the management of HRSP.Conclusion:Nigerian consultant anesthetists employ mostly noninvasive blood pressure, CVP, and invasive blood pressure for HM in HRSP. Though a good knowledge of hemodynamic goals was demonstrated, most rated their practice as inadequate.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hemodynamic monitoring in Nigerian patients undergoing high-risk surgery

Osinaike

2015

Indian Journal of Critical Care Medicine

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“…Evaluation of data offered by recent studies suggests that inspite of minor limitations, changes in arterial pressure track blood flow changes accurately, following a fluid challenge. [ 12 16 17 18 19 ] Thus, we opted to use an arterial pressure-based variable, DD for determining fluid responsiveness. Prior studies done in perioperative and ICU populations using DD showed that a cutoff of 5 mmHg can be used for differentiating fluid responders from NR and can also be used to diagnose hypovolemia and initiate fluid loading.…”

Section: Discussionmentioning

confidence: 99%

Quest for the holy grail: Assessment of echo-derived dynamic parameters as predictors of fluid responsiveness in patients with acute aneurysmal subarachnoid hemorrhage

2018

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Background:Acute aneurysmal subarachnoid hemorrhage (aSAH) is a potentially devastating event often presenting with a plethora of hemodynamic fluctuations requiring meticulous fluid management. The aim of this study was to assess the utility of newer dynamic predictors of fluid responsiveness such as Delta down (DD), superior vena cava collapsibility index (SVCCI), and aortic velocity time integral variability (VTIAoV) in patients with SAH undergoing neurosurgery.Materials and Methods:Fifteen individuals with SAH undergoing surgery for intracranial aneurysmal clipping were enrolled in this prospective study. Postinduction, vitals, anesthetic parameters, and the study variables were recorded as the baseline. Following this, patients received a fluid bolus of 10 ml/kg of colloid over 20 min, and measurements were repeated postfluid loading. Continuous variables were expressed as mean ± standard deviation and compared using Student's t-test, with a P < 0.05 considered statistically significant. The predictive ability of variables for fluid responsiveness was determined using Pearson's coefficient analysis (r).Results:There were 12 volume responders and 3 nonresponders (NR). DD >5 mm Hg was efficient in differentiating the responders from NR (P < 0.05) with a sensitivity and specificity of 90% and 85%, respectively, with a good predictive ability to identify fluid responders and NR; r = 0.716. SVCCI of >38% was 100% sensitive and 95% specific in detecting the volume status and in differentiating the responders from NR (P < 0.05) and is an excellent predictor of fluid responsive status; r = 0.906. VTIAoV >20% too proved to be a good predictor of fluid responsiveness, with a sensitivity and specificity of 100% and 90%, respectively, with a predictive power; r = 0.732.Conclusion:Our study showed that 80% of patients presenting with aSAH for intracranial aneurysm clipping were fluid responders with normal hemodynamic parameters such as heart rate and blood pressure. Among the variables, SVCCI >38% appears to be an excellent predictor followed by VTIAoV >20% and DD >5 mmHg in assessing the fluid status in this population.

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“…From 368 respondents, 35 % routinely monitored cardiac output with similar numbers in Europe and in North America [ 6 ]. A similar survey of members of the Korean Society of Anesthesiologists revealed that 59 % of 139 respondents were using cardiac output monitoring [ 8 ]. The findings of a paper-based survey of Chinese anaesthetists showed that cardiac output monitoring was used by 13 % of 210 respondents [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Variation in haemodynamic monitoring for major surgery in European nations: secondary analysis of the EuSOS dataset

et al. 2015

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BackgroundThe use of cardiac output monitoring may improve patient outcomes after major surgery. However, little is known about the use of this technology across nations.MethodsThis is a secondary analysis of a previously published observational study. Patients aged 16 years and over undergoing major non-cardiac surgery in a 7-day period in April 2011 were included into this analysis. The objective is to describe prevalence and type of cardiac output monitoring used in major surgery in Europe.ResultsIncluded in the analysis were 12,170 patients from the surgical services of 426 hospitals in 28 European nations. One thousand four hundred and sixteen patients (11.6 %) were exposed to cardiac output monitoring, and 2343 patients (19.3 %) received a central venous catheter. Patients with higher American Society of Anesthesiologists (ASA) scores were more frequently exposed to cardiac output monitoring (ASA I and II, 643 patients [8.6 %]; ASA III–V, 768 patients [16.2 %]; p < 0.01) and central venous catheter (ASA I and II, 874 patients [11.8 %]; ASA III–V, 1463 patients [30.9 %]; p < 0.01). In elective surgery, 990 patients (10.8 %) were exposed to cardiac output monitoring, in urgent surgery 252 patients (11.7 %) and in emergency surgery 173 patients (19.8 %). A central venous catheter was used in 1514 patients (16.6 %) undergoing elective, in 480 patients (22.2 %) undergoing urgent and in 349 patients (39.9 %) undergoing emergency surgery. Nine hundred sixty patients (7.9 %) were monitored using arterial waveform analysis, 238 patients (2.0 %) using oesophageal Doppler ultrasound, 55 patients (0.5 %) using a pulmonary artery catheter and 44 patients (2.0 %) using other technologies. Across nations, cardiac output monitoring use varied from 0.0 % (0/249 patients) to 27.5 % (19/69 patients), whilst central venous catheter use varied from 5.6 % (7/125 patients) to 43.2 % (16/37 patients).ConclusionsOne in ten patients undergoing major surgery is exposed to cardiac output monitoring whilst one in five receives a central venous catheter. The use of both technologies varies widely across Europe.Trial registrationClinicalTrials.gov Identifier: NCT01203605. Date of registration: 15.09.2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-015-0018-8) contains supplementary material, which is available to authorized users.

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Current practice in hemodynamic monitoring and management in high-risk surgery patients: a national survey of Korean anesthesiologists

Cited by 12 publications

References 28 publications

Hemodynamic monitoring in Nigerian patients undergoing high-risk surgery

Hemodynamic monitoring in Nigerian patients undergoing high-risk surgery

Quest for the holy grail: Assessment of echo-derived dynamic parameters as predictors of fluid responsiveness in patients with acute aneurysmal subarachnoid hemorrhage

Variation in haemodynamic monitoring for major surgery in European nations: secondary analysis of the EuSOS dataset

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