Right Heart Catheterization and Cardiac Complications in Patients Undergoing Noncardiac Surgery

Polanczyk, Carísi Anne

doi:10.1001/jama.286.3.309

Cited by 229 publications

(49 citation statements)

References 31 publications

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“…We found that patient variables independently associated with PAC use in this study are similar to those of earlier investigations, including high Acute Physiology and Chronic Health Evaluation II scores (9,23), surgical status (22,24), use of mechanical ventilation (24), vasoactive drugs (24,25), and measures of renal insufficiency (9,26). The decline in PAC use is also consistent with time trend analysis on US national estimates of PAC use (27).…”

Section: Discussionsupporting

confidence: 88%

Pulmonary artery catheters: Evolving rates and reasons for use*

Koo

Sun

Zhou

et al. 2011

Critical Care Medicine

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Section: Discussionsupporting

confidence: 88%

Pulmonary artery catheters: Evolving rates and reasons for use*

Koo

Sun

Zhou

et al. 2011

Critical Care Medicine

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“…Comparable results from other groups using a similar goal directed approach lends further support to the importance of avoiding a tissue oxygen debt perioperatively 11 14 15. In large Canadian and US studies, however, placement of a pulmonary artery catheter without targeting predefined haemodynamic end points produced no difference in postoperative outcomes 3 16. In one of the studies there was no significant difference in the volume of fluid given to the two treatment groups (J D Sandham, personal communication, 2003).…”

Section: Discussionmentioning

confidence: 80%

Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery

McKendry

McGloin

Saberi

et al. 2004

BMJ

302

195

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Objective To assess whether a nurse led, flow monitored protocol for optimising circulatory status in patients after cardiac surgery reduces complications and shortens stay in intensive care and hospital. Design Randomised controlled trial. Setting Intensive care unit and cardiothoracic unit of a university teaching hospital. Participants 174 patients who underwent cardiac surgery between April 2000 and January 2003. Interventions Patients were allocated to conventional haemodynamic management or to an algorithm guided by oesophageal Doppler flowmetry to maintain a stroke index above 35 ml/m 2 . Results 26 control patients had postoperative complications (two deaths) compared with 17 (four deaths) protocol patients (P = 0.08). Duration of hospital stay in the protocol group was significantly reduced from a median of nine (interquartile range 7-12) days to seven (7-10) days (P = 0.02). The mean duration of hospital stay was reduced from 13.9 to 11.4 days, a saving in hospital bed days of 18% (95% confidence interval − 12% to 47%). Usage of intensive care beds was reduced by 23% ( − 8% to 59%). Conclusion A nurse delivered protocol for optimising circulatory status in the early postoperative period after cardiac surgery may significantly shorten hospital stay.

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“…This approach should be the best thing to do, but there are limitations that remain a major obstacle: the invasiveness of pulmonary artery catheter and transplumonary dilution technique and the poor accuracy and precision of the non-invasive devices (Vigileo - Edwards Lifesciences, Irvine, CA, USA; LiDCO - LiDCO Ltd, Cambridge, UK; ecc.) [28,29]. On the other hand, in moderate to high risk patient who is scheduled to undergo major surgery expected to last > 180 minute, a GTD approach with the optimization of hemodynamic parameters could reduce complications [8,30].…”

Section: Discussionmentioning

confidence: 99%

Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach?

et al. 2014

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BackgroundFluid management in the perioperative period has been extensively studied but, despite that, “the right amount” still remains uncertain. The purpose of this paper is to summarize the state of the art of intraoperative fluid approach today.DiscussionIn the current medical literature there are only heterogeneous viewpoints that gives the idea of how confusing the situation is. The approach to the intraoperative fluid management is complex and it should be based on human physiology and the current evidence.SummaryAn intraoperative restrictive fluid approach in major surgery may be beneficial while Goal-directed Therapy should be superior to the liberal fluid strategy. Finally, we propose a rational approach currently used at our institution.

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Right Heart Catheterization and Cardiac Complications in Patients Undergoing Noncardiac Surgery

Abstract: No evidence was found of reduction in complication rates associated with use of perioperative RHC in this population. Because of the morbidity and the high costs associated with RHC, the impact of this intervention in perioperative care should be evaluated in randomized trials.

Cited by 229 publications

References 31 publications

Pulmonary artery catheters: Evolving rates and reasons for use*

Pulmonary artery catheters: Evolving rates and reasons for use*

Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery

Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach?

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