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Automated systems for perioperative goal-directed hemodynamic therapy

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Abstract

Perioperative goal-directed hemodynamic therapy (GDHT) has evolved from invasive “supra-physiological” maximization of oxygen delivery to minimally or even noninvasively guided automated stroke volume optimization. Over the past four decades, investigators have simultaneously developed novel monitors, updated strategies, and automated technologies to improve GDHT. Decision support technology, which proposes an intervention based on the patient’s real time physiologic status, was an important step towards automation. Closed-loop systems have now been created to both increase GDHT compliance and decrease physician workload. These automated systems offer an elegant approach to optimize cardiac output and end-organ perfusion during the perioperative period. Most notably, automated preload optimization guided by dynamic indicators of fluid responsiveness has shown its feasibility, safety, and impact. Making the leap into fully automated GDHT has been accomplished on a small scale, but there are considerable challenges that must be surpassed before integrating all hemodynamic components into an automated system during general anesthesia. In this review, we will discuss the evolution and potential future of automated GDHT during the perioperative period.

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Authors and Affiliations

  1. Department of Anesthesiology, Erasme University Hospital, University Libre de Bruxelles, Brussels, Belgium

    Sean Coeckelenbergh

  2. Department of Cardiac Anaesthesia and Intensive Care, CHU Bordeaux, Service d’Anesthésie-Réanimation II, 33000, Bordeaux, France

    Cedrick Zaouter

  3. Department of Anesthesiology Department of Anesthesiology, University of California, San Diego, CA, USA

    Brenton Alexander

  4. Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, USA

    Maxime Cannesson

  5. Department of Anesthesiology and Perioperative Care, University of California Irvine (UCI), 101 the City Drive South, Orange, USA

    Joseph Rinehart

  6. Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), 94270, Le Kremlin-Bicêtre, France

    Jacques Duranteau & Alexandre Joosten

  7. Department of Anesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium

    Philippe Van der Linden

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  1. Sean Coeckelenbergh
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Coeckelenbergh, S., Zaouter, C., Alexander, B. et al. Automated systems for perioperative goal-directed hemodynamic therapy. J Anesth 34, 104–114 (2020). https://doi.org/10.1007/s00540-019-02683-9

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