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Perioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography.

Authors
  • Trauzeddel, R F1
  • Ertmer, M2
  • Nordine, M1
  • Groesdonk, H V3
  • Michels, G4
  • Pfister, R4
  • Reuter, D5
  • Scheeren, T W L6
  • Berger, C1
  • Treskatsch, S7
  • 1 Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. , (Germany)
  • 2 Department of Anesthesiology, Unfallkrankenhaus Berlin, Berlin, Germany. , (Germany)
  • 3 Department of Interdisciplinary Intensive Care Medicine and Intermediate Care, Helios Hospital Erfurt, Erfurt, Germany. , (Germany)
  • 4 Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. , (Germany)
  • 5 Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany. , (Germany)
  • 6 Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. , (Netherlands)
  • 7 Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. [email protected] , (Germany)
Type
Published Article
Journal
Journal of clinical monitoring and computing
Publication Date
Apr 01, 2021
Volume
35
Issue
2
Pages
229–243
Identifiers
DOI: 10.1007/s10877-020-00534-7
PMID: 32458170
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.

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