Impact of Perioperative Haemodynamic Monitoring on Cardiac Morbidity after Major Vascular Surgery in Low Risk Patients. A Randomised Pilot Trial

Abstract

in this study perioperative haemodynamic optimisation was not beneficial.

Guiding Goal-Directed Therapy

“…Insertion of PAC is associated with an increased risk of various perioperative complications such as arrhythmia, air embolism, pneumothorax, and pulmonary artery rupture [38]. Also, some studies have suggested that the use of PAC for critically ill patients does not actually improve outcome [39][40][41][42][43][44]. Even with the current risk-to-reward ratio, this device can still occasionally be useful for critically ill patients with low CO undergoing cardiac surgeries and even more rarely in very sick cardiac patients undergoing non-cardiac surgery.…”

“…Monitoring of mixed venous oxygen saturation (SvO 2 ) has been used as a simple method for evaluating changes in the systemic oxygen supply to demand ratio in various clinical settings [39,41]. Unfortunately, a PAC is currently required to obtain SvO 2 .…”

Revisão sistemática dos marcadores de otiminização da perfusão tecidual em ensaios clínicos aleatórios de cirurgias de alto risco

“…Study or Subgroup Bender, 1997Berlauk, 1991Bishop, 1995Boldt, 1998Bonazzi, 2002Boyd, 1993Chytra, 2007Conway, 2002Donati, 2007Fleming, 1992Gan, 2002Kapoor, 2008Lobo, 2000Lobo, 2006Lopes, 2007Mythen, 1995Pearse, 2005Polonen, 2000Sandham, 2003Shoemaker, 1988Shultz, 1985Sinclair, 1997Stone, 2003Takala, 2000Ueno, 1998Valentine, 1997Velmahos, 2000Venn, 2002Wakeling, 2005Wilson, 1999 Ziegler, 1997…”

“…Study or Subgroup Bishop, 1995Boldt, 1998Chytra, 2007Fleming, 1992Lobo, 2000Lobo, 2006Lopes, 2007Shoemaker, 1988Shultz, 1985 Total (95% CI) Total events Heterogeneity: Chi² = 3.01, df = 6 (P = 0.81); I² = 0% Test for overall effect: Z = 4.92 (P < 0.00001) Bender, 1997Berlauk, 1991Bishop, 1995Boldt, 1998Bonazzi, 2002Boyd, 1993Fleming, 1992Lobo, 2000Lobo, 2006Polonen, 2000Sandham, 2003Shoemaker, 1988Shultz, 1985Takala, 2000Ueno, 1998Valentine, 1997Velmahos, 2000Wilson, 1999 Ziegler, 1997…”

“…Total events Heterogeneity: Chi² = 36.08, df = 17 (P = 0.004); I² = 53% Test for overall effect: Z = 3.01 (P = 0.003) Bender, 1997Berlauk, 1991Bishop, 1995Boldt, 1998Bonazzi, 2002Boyd, 1993Fleming, 1992Kapoor, 2008Lobo, 2000Lobo, 2006Pearse, 2005Sandham, 2003Shoemaker, 1988Takala, 2000Ueno, 1998Valentine, 1997Velmahos, 2000Wilson, 1999 Total (95% CI) Total events Heterogeneity: Chi² = 29.12, df = 15 (P = 0.02); I² = 48% Test for overall effect: Z = 2.54 (P = 0.01) Heyland (1996), talvez a primeira revisão sistemática sobre estudos clínicos aleatórios designados para atingir valores supranormais de IC, IDO2 e IVO2 em pacientes críticos, atribuiu um rigor metodológico e selecionou apenas sete artigos de 64 identificados e concluiu que existe uma tendência não estatisticamente significativa de diminuição da taxa de mortalidade, risco Assim, há a necessidade de constante atualização científica para esse assunto tão complexo e contraditório, motivando esta revisão sistemática e todas as outras que ainda virão, na tentativa de elucidar, baseada na melhor evidência possível, todas as questões pertinentes (Cook and Guyatt 1994).…”