Evaluation of an active decision support system for hemodynamic optimization during elective major vascular surgery

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Surgical Innovation

Background:

• Disparities in patient outcomes can arise from variations in care delivery among healthcare providers.
• Goal-directed therapy (GDT) protocols, when actively supported, may standardize care and improve outcomes.
• This study investigates the feasibility and adherence of an active decision support system (ADSS) for hemodynamic optimization during high-risk vascular surgery.

Purpose of the Study:

• To assess the feasibility and adherence of an active decision support system (ADSS) for hemodynamic management.
• To evaluate the system's role in optimizing fluid, vasopressor, and dobutamine administration.
• To identify limitations and areas for improvement in real-time ADSS for surgical settings.

Main Methods:

• A prospective observational trial was conducted using a closed-loop GDT protocol with the LiDCOrapid device.
• The ADSS provided real-time advice to anesthesiologists during high-risk vascular surgery.
• Interventions were recorded, and deviations from ADSS advice required justification.

Main Results:

• The ADSS was used in 32 patients for 137 hours, with 100% median use relative to surgery time.
• 743 interventions were executed, with 634 (85%) aligning with ADSS recommendations.
• Reasons for non-compliance included hemodynamic instability (6%) and anticipation of surgical events (2%).

Conclusions:

• High compliance rates demonstrate the clinical acceptability and feasibility of the ADSS in vascular surgery.
• The ADSS has the potential to standardize care and reduce outcome disparities.
• Current limitations involve managing rapid hemodynamic changes and factors not yet anticipated by the system.