Enhanced Surgical REcovery program

You Can Make a Difference in Your Patient's Post-Surgical Recovery

While you can't prepare for every potential risk, hemodynamic optimization through perioperative goal-directed therapy (PGDT) may help you avoid a number of the most common preventable post-surgical complications.

For example, insufficient and excessive volume administration may increase the risk for anastomotic leaks and surgical site infection.1
You can make a difference

Reduce post-surgical complications

Reduced A large body of clinical evidence demonstrates hemodynamic optimization through PGDT in moderate to high-risk surgery has been shown to reduce post-surgical complications, including acute kidney injury (AKI), urinary tract infection (UTI), surgical site infection (SSI), pneumonia, major/minor GI complication, hospital length of stay and may improve your patients' postoperative recovery. 2-9 Randomized controlled trials
Meta Analyses

Advanced Hemodynamic Optimization through PGDT

Administering volume in the optimal range is important because both hypo- and hypervolemia may deleteriously affect perioperative organ function. The graphic describes the goal of PGDT. Exceeding or falling short of this range may result in increased morbidity and increased risk of post- surgical complications. Hemodynamic optimization through PGDT using advanced hemodynamic parameters can ensure the patient is maintained in the optimal range.11-12

Dynamicatic Parameters

Conventional fluid management, based on clinical assessment,vital signs and/or central venous pressure (CVP) monitoring, is suboptimal. Indeed, clinical studies have shown that CVP is not able to predict fluid responsiveness12 and that changes in blood pressure cannot be used to track changes in stroke volume (SV) or in cardiac output induced by volume expansion.13

Defining PGDT

Perioperative Goal-Directed Therapy - PGDT.  A clinician-directed treatment protocol, which defines and treats to a goal, using advanced hemodynamic parameters to improve patient outcomes.1-13

Helping to advance the care of the critically ill for 40 years, Edwards Lifesciences seeks to provide the valuable information you need, the moment you need it. Through continuing collaboration with you, ongoing education and our never-ending quest for advancement, our goal is to deliver clarity in every moment.

References
1. Amir A. Ghaferi, A. et al, Variation in Hospital Mortality Associated with Inpatient Surgery, N Engl J Med 2009
2. Arkilic, C. F., Taguchi, A., Sharma, N., Ratnaraj, J., Sessler, D. I., & Read, T. E. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery, 133: 49-55. (2003).
3. Aya H. D., Cecconi M, Hamilton M, and Rhodes A. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. British Journal of Anaesthesia,doi:10.1093/bja/aet020
4. Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study. Crit Care Med 2009;37: 2079–90
5. Cecconi M, Corredor C, Arulkumaran N, Abuella G, Ball J, Grounds R.M., Hamilton M, and Rhodes A. Clinical review: Goal-directed therapy - what is the evidence in surgical patients? The effect on different risk groups. Critical Care 2013, 17:209
6. Dalfino L, Giglio MT, Puntillo F, Marucci M, Brienza N. Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis.Crit Care 2011; 15: R154
7. Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 2009; 103: 637–46
8. Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high risk surgical patients. Anesth Analg 2011; 112: 1392–402
9. Phan T.D., MBBS, FRCA, Ismail H., MD, FFARCS(I), FRCA FANZCA, Heriot A,G, MD, FRCS, FRACS, KwokMHo, MPH, FANZCA, FJFICM. Improving Perioperative Outcomes: Fluid Optimization with the Esophageal Doppler Monitor, a Metaanalysis and Review. American College of Surgeons doi:10.1016/j.jamcollsurg.2008.08.007
10. Grocott, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review. BJA, 2013.
11. Bellamy MC. Wet, dry or something else? Br J Anaesth. 2006;97(6):755-757.
12. Cannesson M. Arterial pressure variation and goal-directed fluid therapy. J Cardiothorac Vasc Anesth. 2010;24(3):487-497.
13. Le Manach et al. Can changes in arterial pressure be used to detect changes in cardiac output during volume expansion in the perioperative period? Anesthesiology 2013.
   
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