Automated systems for perioperative goal-directed hemodynamic therapy
Sean Coeckelenbergh1, Cedrick Zaouter2, Brenton Alexander3
1Department of Anesthesiology, Erasme University Hospital, University Libre de Bruxelles, Brussels, Belgium.
Journal of Anesthesia
|September 27, 2019
Summary
Automated goal-directed hemodynamic therapy (GDHT) optimizes patient circulation using advanced technology. This evolution enhances compliance and reduces workload, paving the way for future perioperative care advancements.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Cardiovascular Physiology
Background:
- Perioperative goal-directed hemodynamic therapy (GDHT) has evolved significantly over four decades.
- Initial approaches focused on invasive oxygen delivery maximization, transitioning towards minimally invasive and noninvasive methods.
- Technological advancements have driven the development of automated strategies for hemodynamic management.
Purpose of the Study:
- To review the evolution of automated GDHT from traditional methods to current advanced systems.
- To discuss the role of decision support and closed-loop systems in perioperative hemodynamic management.
- To explore the future potential and challenges of fully automated GDHT during general anesthesia.
Main Methods:
- Review of historical and current literature on GDHT and automation.
- Analysis of technological advancements in hemodynamic monitoring and therapeutic delivery.
- Discussion of studies evaluating automated preload optimization and its impact.
Main Results:
- Automated systems, including decision support and closed-loop technologies, improve GDHT compliance and reduce physician workload.
- Automated preload optimization guided by dynamic fluid responsiveness indicators is feasible, safe, and impactful.
- Small-scale implementation of fully automated GDHT has been achieved, demonstrating potential.
Conclusions:
- Automated GDHT represents an elegant approach to optimize cardiac output and end-organ perfusion perioperatively.
- Significant challenges remain in integrating all hemodynamic components into a fully automated system for general anesthesia.
- Further research and development are needed to overcome these challenges and realize the full potential of automated GDHT.
More Related Videos
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
290
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
290
01:22Heart Failure VI: Adjunct Therapies
263
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
263
01:30Heart Failure V: Medical Management
223
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
223
01:17Autoregulation of Blood Flow
7.5K
Autoregulation mechanisms are characterized by their inherent capacity for self-regulation without necessitating specific nervous stimulation or endocrine control. These mechanisms facilitate the adjustment of blood flow and, therefore, perfusion specific to each tissue region. This self-regulation encompasses chemical signals and myogenic controls.
Chemical Signaling in Autoregulation
Chemical signaling operates at the precapillary sphincter level, inciting either contraction or relaxation....
Chemical Signaling in Autoregulation
Chemical signaling operates at the precapillary sphincter level, inciting either contraction or relaxation....
7.5K
01:25Hemodialysis III: Nursing Management
758
The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
758
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
679
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
679