Riassunto
L’elevata morbidità e mortalità perioperatoria dei pazienti con insufficienza cardiaca cronica o CHF (chronic heart failure) potranno certamente essere ridotte nei prossimi anni migliorando le capacità diagnostiche degli anestesisti e dei chirurghi e la qualità delle loro strategie di trattamento. (Precisiamo che in questo capitolo la sigla CHF viene usata con riferimento alla tuttora accettata definizione di “Chronic Heart Failure”; in passato la “C” della stessa sigla era utilizzata per definire “Congestive”.)
Il miglioramento delle capacità diagnostiche è soprattutto legato a un affinamento delle conoscenze di semeiotica e a una paziente raccolta delle notizie anamnestiche, poiché, in fase di preparazione del paziente all’intervento, nessun esame strumentale può sostituire queste preziose procedure, anche se può essere utilmente affiancato a esse. L’acume semeiotico è stimolato in modo importante dalla conoscenza approfondita della fisiopatologia della CHF che risulterà altrettanto essenziale nella scelta delle strategie terapeutiche durante e dopo l’intervento. Per guidare correttamente il trattamento sarà tuttavia sempre necessario avvalersi di supporti strumentali che consentano almeno un monitoraggio della CVP (central venous pressure, pressione venosa centrale) e dello stroke volume (SV), atto al controllo continuo, invasivo, della pressione arteriosa.
Il controllo strumentale diventerà invasivo (catetere di Swan-Ganz) nel caso di intervento non procrastinabile in paziente con CHF scompensata. Questo supporto sarà di grande importanza per guidare la terapia infusionale che costituisce un problema di rilievo nel paziente con CHF.
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Allaria, B. (2011). La gestione perioperatoria del paziente con insufficienza cardiaca cronica. In: Allaria, B., Dei Poli, M. (eds) Il monitoraggio delle funzioni vitali nel perioperatorio non cardiochirurgico. Springer, Milano. https://doi.org/10.1007/978-88-470-1723-8_2
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