Haemodynamic monitoring and management in patients having noncardiac surgery

Abstract

BACKGROUND Haemodynamic monitoring and management is a mainstay of peri-operative anaesthetic care. OBJECTIVE To determine how anaesthesiologists measure and manage blood pressure and cardiac output, and how they guide fluid administration and assess fluid responsiveness in patients having noncardiac surgery. DESIGN Web-based survey. SETTING Survey among members of the European Society of Anaesthesiology and Intensive Care (ESAIC) in October and November 2021. PARTICIPANTS ESAIC members responding to the survey. MAIN OUTCOME MEASURES Respondents’ answers to 30 questions on haemodynamic monitoring and management, and fluid therapy. RESULTS A total of 615 fully completed surveys were analysed. Arterial catheters are usually not placed before induction of general anaesthesia (378/615; 61%) even when invasive blood pressure monitoring is planned. Mean arterial pressure (532/615; 87%) with lower intervention thresholds of 65 mmHg (183/531; 34%) or 20% below pre-operative baseline (166/531; 31%) is primarily used to guide blood pressure management. Cardiac output is most frequently measured using pulse wave analysis (548/597; 92%). However, only one-third of respondents (almost) always use cardiac output to guide haemodynamic management in high-risk patients (225/582; 39%). Dynamic cardiac preload variables are more frequently used to guide haemodynamic management than cardiac output [pulse pressure variation (almost) always: 318/589; 54%]. Standardised treatment protocols are rarely used for haemodynamic management (139/614; 23%). For fluid therapy, crystalloids are primarily used as maintenance fluids, to treat hypovolaemia, and for fluid challenges. The use of 0.9% saline and hydroxyethyl starch has declined over the last decade. The preferred methods to assess fluid responsiveness are dynamic preload variables and fluid challenges, most commonly with 250 ml of fluid (319/613; 52%). CONCLUSION This survey provides important information how anaesthesiologists currently measure and manage blood pressure and cardiac output, and how they guide fluid administration in patients having noncardiac surgery.