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

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.

Figure 1

Do you or your department/group manage these patients in the intensive care unit?

Figure 2

Incidence of institutional guidelines concerning hemodynamic management in this setting?

Figure 3

How frequently do you try to optimize central venous pressure, arterial pressure, and cardiac output in this setting?

Figure 4

What technique do you use to monitor cardiac output? (Please, mark all that apply).

Figure 5

What is your first choice solution for volume expansion?