Related Experiment Video
Updated: Mar 10, 2026
Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs
Published on: May 21, 2019
Haemodynamic coherence in perioperative setting
Andrea Carsetti1, Ximena Watson2, Maurizio Cecconi3
1Anaesthesia and Intensive Care Unit, ASUR Marche - Area Vasta n. 4, Italy.
Insights
Goal-directed therapy (GDT) can optimize hemodynamics in high-risk surgery. However, this review highlights that GDT may not always resolve microvascular dysfunction, emphasizing the need for comprehensive assessment.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Surgical Sciences
Background:
- Increased interest in goal-directed therapy (GDT) for high-risk surgery over the past decade.
- Development of various hemodynamic monitoring tools for perioperative care.
- Patient and surgical complexity influence the benefit of GDT.
Purpose of the Study:
- To review hemodynamic optimization strategies in the perioperative period.
- To discuss the assessment of microvascular function during surgery.
- To provide an overview of GDT's role in managing tissue perfusion.
Main Methods:
- Literature review focusing on perioperative hemodynamic management.
- Analysis of the relationship between macrovascular and microvascular circulation.
- Discussion of current monitoring tools and their limitations.
Main Results:
- Hemodynamic optimization using GDT is crucial for perioperative care.
- Global hemodynamic parameters can be improved with GDT.
- Microvascular impairment may persist despite optimized macrovascular hemodynamics.
Conclusions:
- Ensuring optimal tissue perfusion requires addressing both macrovascular and microvascular aspects.
- GDT is a valuable tool, but its application needs careful consideration of patient and surgical factors.
- Further research into microvascular assessment is needed to complement GDT.
Abstract:
Over the last decade, there has been an increased interest in the use of goal-directed therapy (GDT) in patients undergoing high-risk surgery, and various haemodynamic monitoring tools have been developed to guide perioperative care. Both the complexity of the patient and surgical procedure need to be considered when deciding whether GDT will be beneficial. Ensuring optimum tissue perfusion is paramount in the perioperative period and relies on the coherence between both macrovascular and microvascular circulations. Although global haemodynamic parameters may be optimised with the use of GDT, microvascular impairment can still persist. This review will provide an overview of both haemodynamic optimisation and microvascular assessment in the perioperative period.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:17Autoregulation of Blood Flow
Chemical Signaling in Autoregulation
Chemical signaling operates at the precapillary sphincter level, inciting either contraction or relaxation....
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:14Fetal Circulation
Two umbilical arteries transport blood from the fetus to the placenta. At the placenta, the blood absorbs oxygen and nutrients while simultaneously eliminating waste products. This oxygen-enriched and nutrient-rich blood then returns to the fetus through one...
01:30Equipments Used To Measure Blood Pressure
This invasive approach involves cannulating a peripheral artery. During each cardiac contraction, pressure generates mechanical motion within the catheter, transmitted through rigid, fluid-filled tubing to a transducer. This transducer converts mechanical motion into electrical signals displayed as waveforms on a monitor. An automatic flushing system prevents blood backflow. Due to the potential risk of unexpected arterial blood loss, this method is primarily used in intensive...
01:19Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart...