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01.08.2011 | Research | Ausgabe 4/2011 Open Access

Critical Care 4/2011

Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists

Zeitschrift:
Critical Care > Ausgabe 4/2011
Autoren:
Maxime Cannesson, Gunther Pestel, Cameron Ricks, Andreas Hoeft, Azriel Perel
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​cc10364) contains supplementary material, which is available to authorized users.

Competing interests

Maxime Cannesson is a consultant for Edwards Lifesciences (USA), Covidien (USA), Masimo Corp. (USA), ConMed (USA), Philips Medical System (Germany), CNsystem (Austria), BMeye (Netherlands), and Fresenius Kabi (Germany). Gunther Pestel is a consultant for BMeye (Netherlands) and Fresenius Kabi (Germany). Cameron Ricks has no conflict of interest to declare. Andreas Hoeft is a consultant for Edwards Lifesciences (USA). Azriel Perel is a consultant for BMeye (Netherlands), Pulsion (Germany), and FlowSense (Israel).

Authors' contributions

MC designed the study, collected and analyzed the data, drafted the manuscript, and gave final approval of the manuscript. GP designed the study, analyzed the data, drafted the manuscript, and gave final approval of the manuscript. CR collected the data and gave final approval of the manuscript. AH analyzed the data, drafted the manuscript, and gave final approval of the manuscript. AP designed the study, analyzed the data, drafted the manuscript and gave final approval of the manuscript.
All authors read and approved the final version of the manuscript.

Abstract

Introduction

Several studies have demonstrated that perioperative hemodynamic optimization has the ability to improve postoperative outcome in high-risk surgical patients. All of these studies aimed at optimizing cardiac output and/or oxygen delivery in the perioperative period. We conducted a survey with the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA) to assess current hemodynamic management practices in patients undergoing high-risk surgery in Europe and in the United States.

Methods

A survey including 33 specific questions was emailed to 2,500 randomly selected active members of the ASA and to active ESA members.

Results

Overall, 368 questionnaires were completed, 57.1% from ASA and 42.9% from ESA members. Cardiac output is monitored by only 34% of ASA and ESA respondents (P = 0.49) while central venous pressure is monitored by 73% of ASA respondents and 84% of ESA respondents (P < 0.01). Specifically, the pulmonary artery catheter is being used much more frequently in the US than in Europe in the setup of high-risk surgery (85.1% vs. 55.3% respectively, P < 0.001). Clinical experience, blood pressure, central venous pressure, and urine output are the most widely indicators of volume expansion. Finally, 86.5% of ASA respondents and 98.1% of ESA respondents believe that their current hemodynamic management could be improved.

Conclusions

In conclusion, these results point to a considerable gap between the accumulating evidence about the benefits of perioperative hemodynamic optimization and the available technologies that may facilitate its clinical implementation, and clinical practices in both Europe and the United States.
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