The maintenance of adequate circulating blood volume and blood pressure is essential for the delivery of oxygen to the tissues. Individualised haemodynamic management is defined as the act of optimising both the patient’s fluid balance and blood pressure during surgery
Importance of Haemodynamic Management
Up to 70% of patients may exhibit hypovolaemia (reduced circulating blood volume) at the beginning of surgery . The body responds to hypovolaemia by reducing blood flow to some organ systems such as the gut. While this ensures adequate supply is maintained to the heart and brain, decreased blood and oxygen supply to the gut can cause tissue necrosis. In turn this can trigger the leakage of bacteria and toxins from the gut into the bloodstream. These events can result in postoperative complications ranging from nausea and vomiting to multiple organ failure [2,3].
By optimising the patient’s blood flow (Stroke Volume Optimisation) during surgery, postoperative complications attributed to hypo and hypervolaemia can be avoided. Haemodynamic management is a crucial factor for prevention of occult hypovolaemia and subsequent end organ dysfunction.
Improved surgical outcomes
Active haemodynamic measurement means accurate, real-time control over haemodynamic status, and is supported by a large evidence base.
Oesophageal Doppler technology provides the anaesthetist with the capability to manage an individual patient’s perioperative fluid and cardiovascular status in real time and with unparalleled accuracy. The consequence is fewer complications, reduced morbidity and shorter length of stay.
Haemodynamic management is an essential component of any Enhanced Recovery Programme. For this reason ODM was chosen as one of six High Impact Innovations as identified by the UK’s NHS in its 2011 Innovation, Health and Wealth initiative, such is its contribution to improving outcomes after surgery.
Uniquely evidence based
Oesophageal Doppler is the only technology to consistently demonstrate reductions in postoperative complications and length of hospital stay when used to guide haemodynamic management. See the Evidence Table for a summary of haemodynamic management outcome studies.
1. Bundgaard-Nielson, M. et al, Functional intravascular volume deficit in patients before surgery, Acta Anaesthesiol Scand, 2010. 54(4): p.464-9.
2. Deitch, EA, The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure, Arch Surg, 1990. 125(3): p.403-4.
3. Fiddian-Green, RG, Splanchnic ischaemia and multiple organ failure in the critically ill, Ann R Coll Surg Engl, 1988. 70(3): p.128-34.