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Why we believe in a tailored monitoring approach

As much as patients differ from each other, monitoring needs can also vary from patient to patient. Therefore, a customized approach to intraoperative fluid management should be applied to control, track, and observe hemodynamics in a broad range of surgical patients.[1]

In an aging population with increased comorbidity, hemodynamic monitoring has become even more critical today to optimize perioperative fluid management.[1] Close monitoring of hemodynamics during anesthetic induction, surgery and postoperatively is proven to prevent adverse outcomes.[2]

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Studies confirm: improved outcomes through intraoperative fluid management

Numerous studies document that intraoperative individual goal-directed fluid therapy improves outcomes after surgery and has a beneficial input on hospital costs.[2],[4],[5] Additionally, the Enhanced Recovery After Surgery (ERAS) protocols recommend individualized intraoperative fluid optimization through hemodynamic monitoring.[6]

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A lack of perioperative management among high-and medium-risk surgical patients not only demonstrates the potential to cause cardiovascular complications but also can increase the risk of developing neurological complications, kidney damage, and even mortality. [1],[2],[3]

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Yet even basic interventions in healthy patients carry the risk of complications such as hypotension. One of the most important vital signs of patients, the blood pressure, should also be continuously monitored as an indicator of the patient’s condition.[7],[8]

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  1. 1. Yamada T, Vacas S, Gricourt Y, Cannesson M
    Improving Perioperative Outcomes Through Minimally Invasive and Non-invasive Hemodynamic Monitoring Techniques. 2018:Front. Med. 5:144.doi: 10.3389/fmed.2018.00144

  2. 2. Salzwedel C, et al.
    Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care 2013;17(5):R191.

  3. 3. Giglio M, Marucci M, Testini M, Brienza N.
    Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials British Journal of Anaesthesia 103(5):637–46 (2009) doi:10.1093/bja/aep279

  4. 4. Cecconi M, Fasano N, Langiano N, Divella M, Costa M, Rhodes A, Rocca G.
    Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Critical Care 2011, 15:R132.

  5. 5. Michard F, et al.
    Potential return on investment for implementation of perioperative goal-directed fluid therapy in major surgery: a nationwide database study. Perioper Med 2015;4(11).

  6. 6. Mythen MG, Swart M, Acheson N, et al.
    Perioperative fluid management: consensus statement from the Enhanced Recovery partnership. Perioper Med. 2012, 1:2. doi: 10.1186/2047-0525-1-2

  7. 7. Benes J, Haidingerova L, Pouska J et al.
    Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacement. BMC nesthesiol. 2015;15(1).

  8. 8. Stenglova A, Benes J,
    Continuous Non-Invasive Arterial Pressure Assessment during Surgery to Improve Outcome. Front Med (Lausanne). 2017 Nov 17;4:202

  9. 9. Salmasi V, Maheshwari K, Yang D, et al.
    Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis. Anesthesiology 2017;126(1):47-65. https://doi.org/10.1097/ALN.0000000000001432

  10. 10. Bijker J, Persoon S, Linda M. et al.
    Intraoperative Hypotension and Perioperative Ischemic Stroke after General Surgery: A Nested Case-control Study. Anesthesiology 2012;116(3):658-664. https://doi.org/10.1097/ALN.0b013e3182472320

  11. 11. Bellamy MC.
    Wet, dry or something else? Br J Anaesth. 2006;97(6):755-757. doi:10.1093/bja/ael290

  12. 12. Benes J, Giglio M, Brienza N, Michard F.
    The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized Controlled trials. Critical Care. 2014;18(5).

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