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Perioperative hemodynamic optimization - Paediatrics
Insights
The French Society for Anaesthesia and Intensive Care developed nine guidelines for pediatric perioperative hemodynamic optimization. These guidelines, based on rigorous evidence assessment, aim to improve patient care during surgery and intensive care.
Area of Science:
- Anesthesiology and Intensive Care Medicine
- Pediatric Critical Care
- Evidence-Based Medicine
Background:
- The French Society for Anaesthesia and Intensive Care (SFAR) previously issued guidelines on perioperative vascular filling in 2012.
- Updating these guidelines was necessary to incorporate current evidence and best practices in hemodynamic management.
- Perioperative hemodynamic optimization is crucial for improving patient outcomes in surgical and intensive care settings.
Purpose of the Study:
- To develop updated guidelines for perioperative hemodynamic optimization specifically for pediatric patients.
- To systematically review and synthesize the available evidence on hemodynamic management in pediatric perioperative care.
- To provide expert consensus recommendations for clinical practice.
Main Methods:
- A committee of 27 experts, including pediatric specialists, was convened.
- The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was employed to assess evidence quality.
- Guideline questions were formulated using the PICO format, and a Professional Practice Guidelines format was adopted due to limited high-power studies.
Main Results:
- Nine guidelines for pediatric perioperative hemodynamic optimization were formulated with strong expert agreement.
- The guidelines cover key areas including arterial pressure, volume expansion, vasopressors, and inotropes.
- Recommendations could not be formulated for four specific questions due to insufficient evidence.
Conclusions:
- Nine comprehensive guidelines on pediatric perioperative hemodynamic optimization have been established.
- These guidelines reflect a high degree of consensus among the expert panel.
- The recommendations provide a framework for evidence-based hemodynamic management in pediatric perioperative care.
Objective:
The Société Française d'Anesthésie et de Réanimation (SFAR) (French Society for Anaesthesia and Intensive Care) is proposing a set of guidelines for perioperative hemodynamic optimisation.
Design:
A committee of 27 experts, including 3 paediatric experts, was set up. Policy of declaring and monitoring links of interest was applied and respected throughout the process of producing the guidelines. Similarly, no funding was received from any company marketing a healthcare product (drug or medical device). The committee had to follow respectfully the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) method to assess the quality of the evidence on which the guidelines were based.
Methods:
The latest SFAR guidelines on perioperative vascular filling strategy were published in 2012. The experts planned to update these guidelines after analysing the literature using GRADE® methodology, identifying four major fields: arterial pressure, systolic ejection volume and dynamic indices, tissue perfusion indices, volume expansion (excluding transfusion) and/or vasopressors and/or inotropes. Each question was formulated according to the PICO (Patients, Intervention, Comparison, Outcome) format. Due to the very small number of studies that could provide the necessary power to answer the most important major judgement criterion, it was decided, prior to drafting the guidelines, to adopt a Professional Practice Guidelines format rather than a Formalized Guidelines from Experts format. The guidelines were then voted on by all the experts using the GRADE grid method.
Results:
The summary work of experts and the application of the GRADE method resulted in nine guidelines concerning perioperative hemodynamic optimization in paediatrics. Strong agreement was reached on each of these nine guidelines. Finally, for four questions, no recommendation could be formulated.
Conclusion:
Nine guidelines, with a high degree of agreement between experts, on perioperative hemodynamic optimization have been formulated.
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