Skip to main content
SpringerLink
Log in

Perioperative Hemodynamic Optimization: From Clinical to Economic Benefits

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2013

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

  • 2705 Accesses

Abstract

Shoemaker et al. [1] were the first to describe the concept of oxygen debt during major surgical procedures and to demonstrate that perioperative hemodynamic optimization has the potential to improve postoperative outcome. Since then, at least 26 other randomized controlled trials (RCTs) [2–27] have shown that perioperative optimization of stroke volume, cardiac output and/or oxygen delivery (DO2) decreases postoperative morbidity and/or mortality in patients undergoing medium-to-high risk surgery (Table 1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186

    Article  PubMed  CAS  Google Scholar 

  2. Berlauk JF, Abrams JH, Gilmour IJ et al (1991) Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. Ann Surg 214:289–297

    Article  PubMed  CAS  Google Scholar 

  3. Fleming A, Bishop M, Shoemaker W et al (1992) Prospective trial of supranormal values as goals of resuscitation in severe trauma. Arch Surg 127:1175–1179

    Article  PubMed  CAS  Google Scholar 

  4. Boyd O, Grounds M, Bennett E (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699–2707

    Article  PubMed  CAS  Google Scholar 

  5. Mythen MG, Webb AR (1995) Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 130:423–429

    Article  PubMed  CAS  Google Scholar 

  6. Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: a randomised controlled trial. BMJ 315:909–912

    Article  PubMed  CAS  Google Scholar 

  7. Ueno S, Tanabe G, Yamada H et al (1998) Response of patients with cirrhosis who have undergone partial hepatectomy to treatment aimed at achieving supranormal oxygen delivery and consumption. Surgery 123:278–286

    Article  PubMed  CAS  Google Scholar 

  8. Wilson J, Woods I, Fawcett J et al (1999) Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 318:1099–1103

    Article  PubMed  CAS  Google Scholar 

  9. Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J (2000) A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 90:1052–1059

    Article  PubMed  CAS  Google Scholar 

  10. Lobo SMA, Salgado PF, Castillo VG et al (2000) Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med 28:3396–3404

    Article  PubMed  CAS  Google Scholar 

  11. Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P (2002) Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth 88:65–71

    Article  PubMed  CAS  Google Scholar 

  12. Gan TJ, Soppitt A, Maroof M et al (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97:820–826

    Article  PubMed  Google Scholar 

  13. Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C (2002) Randomized controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 57:845–849

    Article  PubMed  CAS  Google Scholar 

  14. McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M (2004) Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ 329:258

    Article  PubMed  Google Scholar 

  15. Wakeling HG, McFall MR, Jenkins CS et al (2005) Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 95:634–642

    Article  PubMed  CAS  Google Scholar 

  16. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED (2005) Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial. Crit Care 9:R687–R693

    Article  PubMed  Google Scholar 

  17. Noblett SE, Snowden CP, Shenton BK, Horgan AF (2006) Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg 93:1069–1076

    Article  PubMed  CAS  Google Scholar 

  18. Chytra I, Pradl R, Bosman R, Pelnar P, Kasal E, Zidkova A (2007) Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial. Crit Care 11:R24

    Article  PubMed  Google Scholar 

  19. Lopes MR, Oliveira MA, Pereira VOS, Lemos IPB, Auler JOC, Michard F (2007) Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit Care 11:R100

    Article  PubMed  Google Scholar 

  20. Donati A, Loggi S, Preiser JC et al (2007) Goal-directed intraoperative therapy reduces morbidity an length of hospital stay in high-risk surgical patients. Chest 132:1817–1824

    Article  PubMed  Google Scholar 

  21. Mayer J, Boldt J, Mengistu AM, Röhm KD, Suttner S (2010) Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial. Crit Care 14:R18

    Article  PubMed  Google Scholar 

  22. Benes J, Chytra I, Altmann P et al (2010) Intraoperative fluid optimization using stroke volume variation in high-risk surgical patients: results of a prospective randomized study. Crit Care 14:R118

    Article  PubMed  Google Scholar 

  23. Janjhi S, Vivian-Smith A, Lucena-Amaro S, Watson D, Hinds CJ, Pearse RM (2010) Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: a randomised controlled trial. Crit Care 14:R151

    Article  Google Scholar 

  24. Cecconi M, Fasano N, Langiano N et al (2011) Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Crit Care 15:R132

    Article  PubMed  Google Scholar 

  25. Pillai P, McEleavy I, Gaughan M et al (2011) A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol 186:2201–2206

    Article  PubMed  Google Scholar 

  26. Figus A, Wade RG, Oakey S, Ramakrishmnan VV (2013) Intraoperative esophageal Doppler hemodynamic monitoring in free perforator flap surgery. Ann Plast Surg (in press)

    Google Scholar 

  27. Ping W, Hong-Wei W, Tai-Di Z (2013) Effect of stroke volume variability-guided intraoperative fluid restriction on gastrointestinal functional recovery. Hepatogastroenterology (in press)

    Google Scholar 

  28. Brienza N, Giglio MT, Marucci M et al (2009) Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study. Crit Care Med 37:2079–2090

    Article  PubMed  Google Scholar 

  29. Giglio MT, Marucci M, Testini M et al (2009) Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Brit J Anaesth 103:637–646

    Article  PubMed  CAS  Google Scholar 

  30. Dalfino L, Giglio MT, Puntillo F et al (2011) Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis. Crit Care 15:R154

    Article  PubMed  Google Scholar 

  31. Hamilton MA, Cecconi M, Rhodes A (2011) A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 112:1392–1402

    Article  PubMed  Google Scholar 

  32. Corcoran T, Rhodes JEJ, Clarke S et al (2012) Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg 114:640–651

    Article  PubMed  Google Scholar 

  33. Kuper M, Gold SJ, Quraishi T et al (2011) Intraoperative fluid management guided by oesophageal Doppler monitoring. BMJ 342:d3016

    Article  PubMed  Google Scholar 

  34. Mythen MG, Swart M, Acheson N et al (2012) Perioperative fluid management: consensus statement from the enhanced recovery partnership. Perioperative Medicine 1:2

    Article  Google Scholar 

  35. Cannesson M, Pestel G, Ricks C, Hoeft A, Perel A (2011) Hemodynamic monitoring and management in patients undergoing high-risk surgery: a survey among North American and European anesthesiologists. Crit Care 15:R197

    Article  PubMed  Google Scholar 

  36. Michard F, Biais M (2012) Rational fluid management: dissecting facts from fiction. Brit J Anaesth 108:369–371

    Article  PubMed  CAS  Google Scholar 

  37. Michard F (2011) The burden of high-risk surgery and the potential benefit of goal-directed strategies. Crit Care 15:447

    Article  PubMed  Google Scholar 

  38. UK clinical research network (2012) Study portfolio. Available at http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=6307. Accessed October 2012

    Google Scholar 

  39. Vincent JL (2010) We should abandon randomized controlled trials in the intensive care unit. Crit Care Med 38:S534–S538

    Article  PubMed  Google Scholar 

  40. Michard F, Cannesson M, Vallet B (2011) Perioperative hemodynamic therapy: quality improvement programs should help to resolve our uncertainty. Crit Care 15:445

    Article  PubMed  Google Scholar 

  41. Cannon CM, Holthaus CV, Zubrow MT, et al (2013) The GENESIS project (generalized early sepsis intervention strategies): a multicenter quality improvement collaborative. J Intensive Care Med (in press)

    Google Scholar 

  42. Pronovost P, Needham D, Berenholtz S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732

    Article  PubMed  CAS  Google Scholar 

  43. Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499

    Article  PubMed  CAS  Google Scholar 

  44. Vincent JL, Rhodes A, Perel A et al (2011) Clinical review: Update on hemodynamic monitoring – a consensus of 16. Crit Care 15:229

    Article  PubMed  Google Scholar 

  45. Gawande A (2010) The Checklist Manifesto. How to Get Things Right. Profile Books Ltd, London

    Google Scholar 

  46. Guest JF, Boyd O, Hart WM et al (1997) A cost analysis of a treatment policy of a deliberate perioperative increase in oxygen delivery in high risk surgical patients. Intensive Care Med 23:85–90

    Article  PubMed  CAS  Google Scholar 

  47. Fenwick E, Wilson J, Sculpher M et al (2002) Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis. Intensive Care Med 28:599–608

    Article  PubMed  Google Scholar 

  48. Boltz MM, Hollenbeak CS, Ortenzi G, et al (2012) Synergistic implications of multiple postoperative outcomes. Am J Med Qual 27:383–390

    Google Scholar 

  49. Bartha E, Davidson T, Hommel A et al (2012) Cost-effectiveness analysis of goal-directed hemodynamic treatment of elderly hip fracture patients. Anesthesiology 117:519–530

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Operative Intensivmedizin und Intermediate Care Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    G. Marx

  2. Critical Care, Edwards Lifesciences, 1 Edwards Way, Irvine, CA, USA

    F. Michard

Authors
  1. G. Marx
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Michard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Marx .

Editor information

Editors and Affiliations

  1. Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent Prof.

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Marx, G., Michard, F. (2013). Perioperative Hemodynamic Optimization: From Clinical to Economic Benefits. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2013. Annual Update in Intensive Care and Emergency Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35109-9_44

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-35109-9_44

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-35108-2

  • Online ISBN: 978-3-642-35109-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation