Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12

Abstract

A significant number of surgical patients are at risk of intra- or post-operative complications or both, which are associated with increased lengths of stay, costs, and mortality. Reducing these risks is important for the individual patient but also for health-care planners and managers. Insufficient tissue perfusion and cellular oxygenation due to hypovolemia, heart dysfunction or both is one of the leading causes of perioperative complications. Adequate perioperative management guided by effective and timely hemodynamic monitoring can help reduce the risk of complications and thus potentially improve outcomes. In this review, we describe the various available hemodynamic monitoring systems and how they can best be used to guide cardiovascular and fluid management in the perioperative period in high-risk surgical patients.

Figure 1

The compromise between accuracy and invasiveness of monitoring systems. CO, cardiac output; PA, pulmonary artery.

Figure 2

Possible choice of monitoring system in relation to a patient’s degree of perioperative risk. CO, cardiac output; PAC, pulmonary artery catheter; PPV, pulse pressure variation; ScvO₂, central venous oxygen saturation.

Figure 3

Both hypo- and hypervolemia are associated with more complications. CVA, cerebrovascular accident; MOF, multiple organ failure.