作者: Koichi Suehiro , Katsuaki Tanaka , Tadashi Matsuura , Tomoharu Funao , Tokuhiro Yamada
DOI: 10.1053/J.JVCA.2014.02.020
关键词:
摘要: Surgical mortality rates range from 0.4% to 4%, with the occurrence of perioperative complications ranging 3% 17%. 2–5 These typically lead an increase in “unnecessary” days hospitalization after surgery. Therefore, identifying high-risk patients and developing strategies aimed at decreasing are issues great importance for anesthesiologists. Various interventions improving surgical outcomes have been examined by previous studies, including goal-directed therapy (GDT), 6–10 glycemic control, 11,12 neuraxial blockade. 13–15 In a recent review, it has suggested that such as hemodynamic optimization, oxygen, anesthesia might decrease mortality. 16 Inadequate tissue perfusion indicated be strongest intraoperative predictor complications. 17 For patients, main cause is more often related inadequate than cardiac events. 18 Perioperative management can successfully optimization output ensure adequate oxygen delivery tissues; this shown improve postoperative reduce length hospital stay. 7,10,19–23 several studies focused on monitor was used bring patient plateau Frank-Starling curve. A pulmonary artery catheter (PAC) intermittent thermodilution clinical standard measurement. However, use invasive monitoring decreased, and, consequently, there increased minimally techniques operating rooms intensive care units (ICU). The term, “minimally monitoring,” indicates any technique less than, PAC; currently, include Vigileo-FloTrac TM system, PiCCO monitor, LiDCO transesophageal echocardiography, pressure recording analytic method (PRAM). 24 system (Edwards LifeSciences, Irvine, CA) requires proprietary transducer, which attached radial or femoral arterial connected Vigileo monitor. no external calibration. estimation output, deviation (SD) pulse sampled 20 seconds normal stroke volume (SV) based patients’ demographic data (height, weight, age, gender). Further, also correlated database contains information regarding measured using PAC various settings. Vascular resistance compliance estimated waveform analysis. last 5 years, these measurement algorithms improved repeatedly conflicting early validation studies. Further software improvements addressed problem limited accuracy under low systemic vascular (SVR) states, specific conditions. acute SVR changes remains issue major concern. Some raised questions about validity provided system. 25,26 authors performed review reliability aim provide ability measure track well assess variation (SVV)