Role of Perioperative Hemodynamic Optimization in Reducing Perioperative Mortality

Abstract

Perioperative mortality in non-cardiac surgery is still above the level expected despite anesthetic and surgical progress made (>10 % in high-risk surgical patients). Different techniques and treatments were introduced in the clinical practice to improve the outcome. Among the treatments considered is hemodynamic optimization (goal-directed therapy); it involves monitoring and pharmacological manipulation of the cardiovascular function with the aim of maintaining a constant tissue oxygenation. Four meta-analyses of randomized controlled trials concerning hemodynamic optimization are the meaningful evidence on perioperative decrease in mortality. Goal-directed therapy allows to counterbalance the perioperative increased oxygen consumption with adequate delivery, preventing tissue hypoxia. A key element of hemodynamic optimization is given by the CO or CI, as it can be rapidly monitored and adapted to the patient’s bedside. Different systems of hemodynamic monitoring with different methods and invasiveness can estimate the stroke volume (SV) and, from this, to obtain the cardiac output value. In conclusion, hemodynamic monitoring is effective in significantly reducing the mortality when perioperative tissue perfusion is maintained through a broader management practice that involves the patient before, during, and after surgery.