Perioperative Haemodynamic Optimization Strategies in HighRisk Surgical Patients

Abstract

Millions of surgical procedures are performed globally each year. High-risk surgical procedures have varying but generally, high mortality and morbidity rates, making them a global challenge. In order to lower the risk of postoperative morbidity and mortality, perioperative haemodynamic optimization strategies have been designed. They are also referred to as goal-directed therapy. These guidelines for managing high-risk surgical patients propose strict adherence to values of mean arterial pressure not to fall below 65 mmHg during surgery, as mean arterial pressure significantly influences organ perfusion. It is recommended to utilize dynamic indicators to guide fluid administration in a substantial portion of non-cardiac surgery cases. However, it is advised to implement a checklist of validity criteria prior to administering volume expansion, acknowledging the recognized limitations of these indices. To tailor fluid therapy appropriately for individual patients and prevent fluid overload, it is commonly recommended to employ minimally invasive or non-invasive monitoring of stroke volume/cardiac output, particularly for patients undergoing moderate- to high-risk surgeries. Furthermore, these strategies suggest combining fluid administration with vasoconstrictors to sustain optimal blood flow and maintain perfusion pressure above hazardous thresholds. Incorporating personalized hemodynamic optimization approaches to reduce postoperative complications, shorten hospital stays, and ultimately prevent mortality in high-risk surgical patients has become a crucial aspect of standard surgical care. This review aims to assess strategies for optimizing perioperative hemodynamics in high-risk surgical patients.