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Perioperative hemodynamic optimization: from guidelines to implementation-an experts' opinion paper.

dc.rights.licenseopenen_US
dc.contributor.authorFELLAHI, Jean-Luc
dc.contributor.authorFUTIER, Emmanuel
dc.contributor.authorVAISSE, Camille
dc.contributor.authorCOLLANGE, Olivier
dc.contributor.authorHUET, Olivier
dc.contributor.authorLORIAU, Jerôme
dc.contributor.authorGAYAT, Etienne
dc.contributor.authorTAVERNIER, Benoit
hal.structure.identifierBiologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases
dc.contributor.authorBIAIS, Matthieu
dc.contributor.authorASEHNOUNE, Karim
dc.contributor.authorCHOLLEY, Bernard
dc.contributor.authorLONGROIS, Dan
dc.date.accessioned2023-01-11T14:38:07Z
dc.date.available2023-01-11T14:38:07Z
dc.date.issued2021-04-14
dc.identifier.issn2110-5820en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/171660
dc.description.abstractEnDespite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a "validity criteria checklist" before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients.
dc.language.isoENen_US
dc.subject.enBlood pressure ; Fluid responsiveness ; Health costs ; Hemodynamic optimization ; High-risk surgery ; Perioperative morbidity ; Vasopressors
dc.title.enPerioperative hemodynamic optimization: from guidelines to implementation-an experts' opinion paper.
dc.title.alternativeAnn Intensive Careen_US
dc.typeArticle de revueen_US
dc.subject.halSciences du Vivant [q-bio]/Médecine humaine et pathologieen_US
dc.identifier.pubmed33852124en_US
bordeaux.journalAnnals of Intensive Careen_US
bordeaux.page58en_US
bordeaux.volume11en_US
bordeaux.hal.laboratoriesBiologie des maladies cardiovasculaires (BMC) - UMR 1034en_US
bordeaux.issue1en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.import.sourcepubmed
hal.exportfalse
workflow.import.sourcepubmed
dc.rights.ccPas de Licence CCen_US
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