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Hemodynamic monitoring and management of patients undergoing high-risk surgery: a survey among Chinese anesthesiologists.

Chen G, Zuo Y, Yang L, Chung E, Cannesson M - J Biomed Res (2014)

Bottom Line: Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV, SPV and CO during fluid management in high-risk surgical patients.The lack of CO monitoring may be attributed largely to the limited access to technologies, the cost of the devices and the lack of education on how to use them.There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China. ; Department of Anesthesiology and Perioperative Care, University of California, Irvine, California.

ABSTRACT
Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery. However, hemodynamic management practices among Chinese anesthesiologists are largely unknown. This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China. From September 2010 to November 2011, we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces. All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists. Once completed, the 29-item questionnaires were collected and analyzed. Two hundred and 10 questionnaires from 265 hospitals in China were collected. We found that 91.4% of anesthesiologists monitored invasive arterial pressure, 82.9% monitored central venous pressure (CVP), 13.3% monitored cardiac output (CO), 10.5% monitored mixed venous saturation, and less than 2% monitored pulse pressure variation (PPV) or systolic pressure variation (SPV) during high-risk surgery. The majority (88%) of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80% relied on blood pressure, CVP and urine output. Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV, SPV and CO during fluid management in high-risk surgical patients. The lack of CO monitoring may be attributed largely to the limited access to technologies, the cost of the devices and the lack of education on how to use them. There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.

No MeSH data available.


Incidence of institutional guidelines concerning hemodynamic management in this setting.
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f01: Incidence of institutional guidelines concerning hemodynamic management in this setting.

Mentions: Approximately 80% (210) of the questionnaires were collected from 265 hospitals (Table 1). Only 189 (71.3%) questionnaires were completed. About half (45.2%) of the surveyed anesthesiologists worked in academic teaching hospitals, while the other half (47.1%) worked in non-teaching hospitals. About three-quarters (75.7%) of those surveyed take care of high-risk surgical patients 1 to 5 times a week but only 10.5% do it 6 to 10 times a week. Only 11.9% of surveyed anesthesiologists take care of cardiac surgery patients. A little less than half (42.9%) had an additional one year of fellowship training: including cardiac anesthesia (15.7%), critical care medicine (12.9%), pediatric anesthesia (4.3%) and pain medicine (2.9%). In addition, 38.6% of those surveyed had finished their training after 2000 and none had finished residency before 1980. Many (39.5%) manage high risk surgery patients in the intensive care unit (Fig. 1). The majority (61.4%) responded work in hospitals with more than 1,000 beds, but only 38.6% of their primary hospitals have more than 40 intensive care unit beds.


Hemodynamic monitoring and management of patients undergoing high-risk surgery: a survey among Chinese anesthesiologists.

Chen G, Zuo Y, Yang L, Chung E, Cannesson M - J Biomed Res (2014)

Incidence of institutional guidelines concerning hemodynamic management in this setting.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4197388&req=5

f01: Incidence of institutional guidelines concerning hemodynamic management in this setting.
Mentions: Approximately 80% (210) of the questionnaires were collected from 265 hospitals (Table 1). Only 189 (71.3%) questionnaires were completed. About half (45.2%) of the surveyed anesthesiologists worked in academic teaching hospitals, while the other half (47.1%) worked in non-teaching hospitals. About three-quarters (75.7%) of those surveyed take care of high-risk surgical patients 1 to 5 times a week but only 10.5% do it 6 to 10 times a week. Only 11.9% of surveyed anesthesiologists take care of cardiac surgery patients. A little less than half (42.9%) had an additional one year of fellowship training: including cardiac anesthesia (15.7%), critical care medicine (12.9%), pediatric anesthesia (4.3%) and pain medicine (2.9%). In addition, 38.6% of those surveyed had finished their training after 2000 and none had finished residency before 1980. Many (39.5%) manage high risk surgery patients in the intensive care unit (Fig. 1). The majority (61.4%) responded work in hospitals with more than 1,000 beds, but only 38.6% of their primary hospitals have more than 40 intensive care unit beds.

Bottom Line: Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV, SPV and CO during fluid management in high-risk surgical patients.The lack of CO monitoring may be attributed largely to the limited access to technologies, the cost of the devices and the lack of education on how to use them.There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China. ; Department of Anesthesiology and Perioperative Care, University of California, Irvine, California.

ABSTRACT
Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery. However, hemodynamic management practices among Chinese anesthesiologists are largely unknown. This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China. From September 2010 to November 2011, we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces. All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists. Once completed, the 29-item questionnaires were collected and analyzed. Two hundred and 10 questionnaires from 265 hospitals in China were collected. We found that 91.4% of anesthesiologists monitored invasive arterial pressure, 82.9% monitored central venous pressure (CVP), 13.3% monitored cardiac output (CO), 10.5% monitored mixed venous saturation, and less than 2% monitored pulse pressure variation (PPV) or systolic pressure variation (SPV) during high-risk surgery. The majority (88%) of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80% relied on blood pressure, CVP and urine output. Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV, SPV and CO during fluid management in high-risk surgical patients. The lack of CO monitoring may be attributed largely to the limited access to technologies, the cost of the devices and the lack of education on how to use them. There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.

No MeSH data available.