Abstract
BackgroundThe use of cardiac output monitoring may improve patient outcomes after major surgery. However, little is known about the use of this technology across nations.MethodsThis is a secondary analysis of a previously published observational study. Patients aged 16 years and over undergoing major non-cardiac surgery in a 7-day period in April 2011 were included into this analysis. The objective is to describe prevalence and type of cardiac output monitoring used in major surgery in Europe.ResultsIncluded in the analysis were 12,170 patients from the surgical services of 426 hospitals in 28 European nations. One thousand four hundred and sixteen patients (11.6 %) were exposed to cardiac output monitoring, and 2343 patients (19.3 %) received a central venous catheter. Patients with higher American Society of Anesthesiologists (ASA) scores were more frequently exposed to cardiac output monitoring (ASA I and II, 643 patients [8.6 %]; ASA III–V, 768 patients [16.2 %]; p < 0.01) and central venous catheter (ASA I and II, 874 patients [11.8 %]; ASA III–V, 1463 patients [30.9 %]; p < 0.01). In elective surgery, 990 patients (10.8 %) were exposed to cardiac output monitoring, in urgent surgery 252 patients (11.7 %) and in emergency surgery 173 patients (19.8 %). A central venous catheter was used in 1514 patients (16.6 %) undergoing elective, in 480 patients (22.2 %) undergoing urgent and in 349 patients (39.9 %) undergoing emergency surgery. Nine hundred sixty patients (7.9 %) were monitored using arterial waveform analysis, 238 patients (2.0 %) using oesophageal Doppler ultrasound, 55 patients (0.5 %) using a pulmonary artery catheter and 44 patients (2.0 %) using other technologies. Across nations, cardiac output monitoring use varied from 0.0 % (0/249 patients) to 27.5 % (19/69 patients), whilst central venous catheter use varied from 5.6 % (7/125 patients) to 43.2 % (16/37 patients).ConclusionsOne in ten patients undergoing major surgery is exposed to cardiac output monitoring whilst one in five receives a central venous catheter. The use of both technologies varies widely across Europe.Trial registrationClinicalTrials.gov Identifier: NCT01203605. Date of registration: 15.09.2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-015-0018-8) contains supplementary material, which is available to authorized users.
Highlights
The use of cardiac output monitoring may improve patient outcomes after major surgery
Cardiac output monitoring has been recommended for patients undergoing selected types of major surgery both by the National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK) and in a report commissioned by the Centers for Medicare and Medicaid Services in the USA [21, 22]
Across European nations, cardiac output monitoring use varied from 0.0 % (0/249 patients) to 27.5 % (19/69 patients) and the use of central venous catheter (CVC) from 5.6 % (7/125 patients) to 43.2 % (16/37 patients) (Fig. 3)
Summary
The use of cardiac output monitoring may improve patient outcomes after major surgery. The dose of intravenous fluid and vasoactive drugs has an important effect on patient outcomes following major gastrointestinal surgery [4]. These treatments are prescribed according to subjective criteria leading to wide variation in clinical practice [5,6,7,8,9]. One potential solution to this problem is the use of cardiac output monitoring to guide administration of intravenous fluid and vasoactive drugs [4]. Cardiac output monitoring has been recommended for patients undergoing selected types of major surgery both by the National Institute for Health and Care Excellence (NICE) in the UK and in a report commissioned by the Centers for Medicare and Medicaid Services in the USA [21, 22]. Clinician surveys and anecdotal evidence suggest there is wide variation in the use of this technology [6,7,8,9]
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