Current practices in hemodynamic monitoring and management during non-cardiac surgery in Austria

Intraoperative hemodynamic monitoring has advanced significantly over the past few decades, enhancing patient safety and improving perioperative outcomes. This survey aimed to examine current practices in intraoperative hemodynamic management in Austria.

Between January 2024 and February 2024, members of the Austrian Society of Anesthesiology, Resuscitation, and Intensive Care Medicine (ÖGARI) with a registered email address (n = 1,839) were invited to participate in an anonymous web-based survey.

A total of 201 questionnaires were received, of which 177 were fully completed. When using intermittent oscillometry, 40% (71/177) of respondents measure blood pressure every three minutes during anesthesia induction. Nearly 45% (80/177) routinely insert an arterial catheter before anesthesia induction, using mean arterial pressure (MAP) to Guide blood pressure management. While 36% (61/168) consider a MAP of 60 mmHg critically low, 48% (80/168) set the threshold at 65 mmHg. Intraoperative hypotension is predominantly managed at individual discretion by 79% (140/177), while 12% (21/177) follow institutional standardized protocols. A pulse contour analysis monitor is available in 94% (166/177) of respondents, with 49% (87/177) reporting frequent use. Regarding the limited use of advanced hemodynamic monitoring in high-risk non-cardiac surgery patients, 64% (113/177) perceived its added value as too low, while 57% (100/177) cite a lack of experience in interpreting the parameters as a barrier to implementation.

This survey among ÖGARI members provides key insights into intraoperative hemodynamic monitoring in Austrian hospitals. The findings suggest that respondents largely follow international recommendations, particularly concerning general blood pressure thresholds, measurement intervals, and indications for advanced hemodynamic monitoring. However, hemodynamic management appear to be only partially standardized, with decisions primarily left to the discretion of the anesthetist.

The study was prospectively registered in the German Clinical Trials Register (DRKS; registration number DRKS00033181 on December 6, 2023).