Fill the Tank, Optimize Flow, Maintain Pressure: Interview at ASA Congress

Anesthesiology 2019 (#ANES19), which took place last weekend in Orlando, was also the venue for an interview with top anesthesiologist, Prof. Michael Scott from Virginia Commonwealth University (VCU) Hospital. Click here to link to the TopMedTalk discussion.

TopMedTalk’s online blog is the latest innovation in the dissemination of medical news. Members of its expert team speak to some of the top professionals in their field and share their interactions with a broad healthcare audience.

This time in front of the microphone it was Prof. Michael Scott, a U.S based British anesthesiologist with an impressive track record in both the UK and now at VCU.  Dr Scott’s gift lies in the recognition that hemodynamic therapy is a vital component in helping to deliver improvements in surgical outcomes. Importantly Prof. Scott talks of how to implement hemodynamic management protocols in a way that brings the extended care team along too. As he puts it, “hemodynamic therapy is important to get right,” but a “real challenge in a hospital system.”

Prof. Scott talks of using different types of hemodynamic monitoring technology, including Esophageal Doppler (EDM) and the impact on reducing Acute Kidney Injury (AKI) (down to <2% from 8-10%, which is consistent with the recent FEDORA multi center study).

He shares the early signs from the implementation of a hemodymanic therapy protocol in all surgical patients at VCU. He specifically references a change from high levels of AKI to only having 2 stage 1 incidences in the first three weeks.

The discussion group  concludes that “fixing flow and pressure” reduces delirium, sepsis, reintubation rates, AKI, surgical site infection and yields overall improvement of outcomes from surgery.

And when asked “Will I get back more money than I’m spending?” the answer was an unequivocal “yes, you’re up on the deal.”

The discussion offers a fascinating insight into the implementation of a hemodynamic management protocol in a hospital system. While this is clearly not easy, the case for the standardization of monitoring practices that extend well beyond blood pressure is supported by unequivocal evidence.

Deltex Medical CEO Andy Mears summarises; “It’s encouraging to hear clinicians embracing technologies such as our own Esophageal Doppler and to protocolise these for all surgical patients within their hospital. This is not least because we’ve been seeing the supportive evidence building up for years now. At Deltex we’re extremely proud to be improving patient safety with a technology that stands alone in providing evidence, accuracy and real-time hemodynamic data.”

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