Perioperative hemodynamic management 4.0

Postoperative complications within 30 days represent the third leading cause of death in the world. Multiple solutions have been proposed to tackle the clinical and economic burden of postoperative complications. They include the optimal fluid and hemodynamic management of patients undergoing major surgery. Technological innovations and a better understanding of cardiovascular physiology underlie the evolution of perioperative hemodynamic management, ranging from the mere normalization of heart rate, blood pressure, and central venous pressure to oxygen delivery maximization with a pulmonary artery catheter and individualized fluid management with esophageal Doppler or pulse contour methods. The concept of personalized hemodynamic management recently emerged and may soon become a reality, because of new technologies enabling noninvasive measurement of cardiac output, not only during and after but also before surgery. The monitoring of microcirculation and tissue perfusion may help to fine tune this approach. Importantly, mortality within 30 days after surgery is 1000 times higher than intraoperative mortality. Therefore, continuous ward monitoring with wireless and wearable sensors may be the next major opportunity to improve patient safety.