Role of Multimodal Monitoring (MMM) in the Perioperative Period: Improving Outcomes in High Risk Surgical Patients

2016 ◽  
pp. 271-300
Author(s):  
D. Green
Keyword(s):  
High Risk ◽  
Perioperative Period ◽  
Surgical Patients ◽  
Multimodal Monitoring

Deliberate Increase of Oxygen Delivery in the Perioperative Period

2018 ◽  
pp. 34-38
Keyword(s):  
Oxygen Consumption ◽  
High Risk ◽  
Cardiac Index ◽  
Oxygen Delivery ◽  
Myocardial Oxygen Consumption ◽  
Perioperative Period ◽  
Surgical Patients ◽  
Controlled Study ◽  
Surgical Patient ◽  
Mortality And Morbidity

This case focuses on increasing the amount of oxygen delivered to the surgical patient during the perioperative period by asking the question: Does the deliberate increase in oxygen delivery with the use of perioperative dopexamine reduce mortality and morbidity in high-risk surgical patients? Dopexamine is a dopamine analogue that produces peripheral vasodilation and an increase in cardiac index without significant increases in myocardial oxygen consumption. High-risk surgical patients were randomized to control or protocol limbs of the study. This randomized controlled study demonstrated a significant reduction in mortality and morbidity when dopexamine was used to increase oxygen delivery during the perioperative period in high-risk surgical patients.

scholarly journals Role of the Photoplethysmographic Waveform in the Care of High-risk Surgical Patients

2013 ◽  
Vol 118 (6) ◽  
pp. 1479-1480 ◽  
Author(s):  
Kirk H. Shelley ◽  
Aymen A. Alian ◽  
Adam J. Shelley
Keyword(s):  
High Risk ◽  
Surgical Patients

scholarly journals Multimodal Monitoring With Haemodynamic Optimisations May Offer Some Benefit for Patients Undergoing Major Abdominal Surgery. A Randomised, Controlled Trial.

2020 ◽  
Author(s):  
Matej Jenko ◽  
Katarina Mencin ◽  
Vesna Novak-Jankovic ◽  
Alenka Spindler-Vesel
Keyword(s):  
High Risk ◽  
Abdominal Surgery ◽  
Hospital Stay ◽  
Postoperative Morbidity ◽  
Fluid Management ◽  
Major Abdominal Surgery ◽  
Surgical Patients ◽  
Haemodynamic Monitoring ◽  
Control Group ◽  
Multimodal Monitoring

Abstract Background: Combined monitoring of blood flow with assessment of fluid status and cerebral tissue oxygenation improve perioperative management and outcome of high-risk surgical patients. The study tests if intraoperative multimodal monitoring reduces postoperative morbidity and duration of hospitalisation in patients undergoing major abdominal surgery managed by same anaesthetic protocols with epidural analgesia.Methods: Prospective study was conducted in 2 parallel groups. High risk surgical patients undergoing major abdominal surgery were randomised in control group (CG), where standard monitoring was applied and protocol group (PG), where cerebral oxygenation and haemodynamic monitoring were used with protocol for intraoperative interventions.Results: There was no difference in median length of hospital stay, CG 9 days (IQR 8 days), PG 9 (5.5), p= 0.851. There was no difference in postoperative renal of cardiac impairment. Procalcitonin was significantly higher (highest postoperative value in first 3 days) in CG, 0.75 mcg/L (IQR 3.19mcg/L), than in PG 0.3 mcg/L (0.88 mcg/L), p= 0.001. Patents in PG received larger intraoperative amount of fluids; median intraoperative fluid balance +1300 ml (IQR 1063ml) than CG; +375 ml (IQR 438ml), p<0.00.Conclusions: There was no difference in postoperative morbidity or hospital stay. Median postoperative value of procalcitonin was significantly higher in CG and was above laboratory reference range. There were significant differences in intraoperative fluid management.Trial registration: ClinicalTrials.gov, NCT02293473, Registered June 10, 2014, https://clinicaltrials.gov/

Role of Oxygen Debt in the Development of Organ Failure Sepsis, and Death in High-Risk Surgical Patients

CHEST Journal ◽  
1992 ◽  
Vol 102 (1) ◽  
pp. 208-215 ◽  
Author(s):  
William C. Shoemaker ◽  
Paul L. Appel ◽  
Harry B. Kram
Keyword(s):  
High Risk ◽  
Organ Failure ◽  
Oxygen Debt ◽  
Surgical Patients

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

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