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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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HEMODYNAMIC MONITORING  SMART 2002 Milan, May 29-31, 2002FREEfree

Minerva Anestesiologica 2002 April;68(4):226-30


language: English

Importance of monitoring in high risk surgical patients

Ingelmo P., Barone M., Fumagalli R.

From the Department of Anesthesia and Resuscitation Ospedali Riuniti, Bergamo (Italy)


­Increased meta­bol­ic require­ments by sur­gi­cal trau­ma is respon­sible of the chang­es in car­diac ­index and oxy­gen deliv­ery (DO2), rep­re­sent com­pen­sa­to­ry adap­ta­tion in cir­cu­la­to­ry func­tions stim­u­lat­ed by ­increased meta­bol­ic ­needs. The ­amount of ­this com­pen­sa­tion var­ies ­with age, gen­der, sever­ity of ill­ness, oper­a­tion ­type, asso­ciat­ed med­i­cal con­di­tions, ­shock dura­tion, com­pli­ca­tions, ­organ fail­ure, and out­come. Hypo­ten­sion, low car­diac ­index, arte­ri­al hemo­glo­bin desat­u­ra­tion, low oxy­gen deliv­ery, and low oxy­gen con­sump­tion ­served and some­times are per­sis­tent ­over ­time; ­these abnor­mal­ities ­were ­more noto­ri­ous in the “non­sur­vi­vors” ­than in the “sur­vi­vors”. ­Lethal cir­cu­la­to­ry dys­func­tions may ­begin dur­ing the intra­op­er­a­tive peri­od but ­become ­more appar­ent ­before and are respon­sible of ­organ fail­ure dur­ing post­op­er­a­tive stag­es. An ­approach ­that meas­ures ade­qua­cy of tis­sue per­fu­sion is a fun­da­men­tal objec­tive in anes­the­sia and crit­i­cal ­care med­i­cine. Tra­di­tion­al meas­ures of tis­sue per­fu­sion ­have includ­ed arte­ri­al pres­sure mon­i­tor­ing, ­urine out­put, arte­ri­al pH and ­blood lac­tate. ­These meas­ures ­have ­major lim­i­ta­tions, and chang­es in ­these meas­ures may sig­nif­i­cant­ly lag ­behind clin­i­cal inter­ven­tions. ­After trau­ma and ­major sur­gery ­despite nor­mal­iza­tion of ­these var­i­ables, glo­bal tis­sue hypox­ia may ­still per­sist. Unrec­og­nized or untreat­ed con­di­tions may ­lead to ­organ fail­ure and ­death. In crit­i­cal or ­high ­risk ­patients, ear­ly inva­sive mon­i­tor­ing is nec­es­sary to pre­cise­ly ­define the ade­qua­cy of the car­diac ­response and to indi­vid­u­al­ly tail­or ther­a­py. The ­care pro­vid­ed in the ­first ­hours sig­nif­i­cant­ly ­impacts the pro­gres­sion of ­organ fail­ure and mor­tal­ity. ­Although ­this peri­od is ­brief com­pared ­with the ­total ­length of hos­pi­tal­iza­tion, phys­io­log­i­cal deter­mi­nants of out­come may be estab­lished ­before ICU admis­sion. Ear­ly post­op­er­a­tive mon­i­tor­ing ­revealed dif­fer­enc­es in sur­vi­vor and non­sur­vi­vor pat­terns and pro­vid­ed ­goals for improv­ing out­come.

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