Perioperative medicine as a distinct clinical science: Good news for Deltex

A newly published paper in the Journal of the American Medical Association (JAMA) reminds us just what a sweet spot Deltex is in. The theme is that as the population increasingly ages, so does the demand for what it calls “unique and nuanced medical care,” especially of high risk patients. One such nuance is the management of fluid levels. The implication is that accurate haemodynamic monitoring leads to optimised fluid levels, leads to optimised organ perfusion and, most significantly, optimised outcome.

The authors tell us that an ageing population means an increase in the number of patients with chronic comorbid conditions when they present for surgery or otherwise require critical care. Joining the dots, this is a driver towards adoption of modern medical management practices to ensure positive outcomes from these high risk patients.

The paper provides examples of hypertension and hypotension both leading to a high risk of adverse post-surgical outcomes. The implication is that closer control of perioperative blood pressure(BP) is desirable. However, it can also be tricky. It’s confounded by factors that influence BP that are specific to the situation. These include (says the paper), “IV volume shifts, changes in sympathetic tone due to onset and offset of anaesthetic agents, surgical stimulation, autonomic stress responses and pain.”

The paper hints at the mechanisms by which BP can impact on organs. It states; “BP, via its ultimate physiologic derivative of perfusion has a major role in patterns and degree of postoperative organ injury.”

Perfect storm

In a nutshell then, the implication is that we live in a world where anaesthetic care is becoming more challenging:

• an ageing population means more patients requiring anaesthetic care carry “high risk” comorbidities
• there are known negative consequences of hypo and hyper tension in perioperative and critical care settings
• these can be explained by the physiologic consequences of  variable organ perfusion

The final piece of the jigsaw is what we can do about it. This is where Deltex’s haemodynamic monitoring expertise comes into play. As the ultimate in delivery of accurate, real-time fluid status, the ODM+ system makes a compelling case for itself. Clinical experts are saying we should effectively walk over hot coals to deliver modern day, nuanced medical care to a population that increasingly needs it. In so doing we can optimise outcomes for high risk patients and minimise adverse outcomes (and therefore costs). Moreover, powerful monitoring technology exists to guide delivery of all of the above.

Outcomes associated with perfusion: further evidence

And then we read that the star paper at this year’s AAGBI (Anaesthetics Association of GB and Ireland) in Liverpool, talks of “critical organ hypoperfusion and ischaemic postoperative complications” being “independently associated with poorer outcomes.”

Of course this is something we already knew. The evidence that goal-directed fluid therapy predicts better outcomes is solid, accepted and forms clinical guidance from UK’s NICE and the NHS Innovation Health and Wealth, High Impact Innovations to name but two.

The evidence reinforces the message that better monitoring-driven control of haemodynamic status results in better outcomes for patients and lower costs for healthcare providers.

At Deltex we bear witness to that evidence in practice every day, so we’re unlikely to argue.

References:

Perioperative Management of High-Risk Patients Going Beyond “Avoid Hypoxia and Hypotension”: Solomon Aronson, MD, MBA; Monty G. Mythen, MBBS, MD, FRCA, FFICM, FCAI (Hon): JAMA. Published online September 27, 2017. doi:10.1001/jama.2017.13699

Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2): S. M. White, I. K. Moppett, R. Griffiths, A. Johansen, R. Wakeman, C. Boulton, F. Plant, A. Williams, K. Pappenheim, A. Majeed, C. T. Currie, M. P. W. Grocott: First published: 4 March 2016, Anaesthesia, 71: 506–514. doi:10.1111/anae.13415