All this monitoring…what's necessary, what's not? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014;17(1):81-90
Date
04/15/2014Pubmed ID
24725722DOI
10.1053/j.pcsu.2014.01.010Scopus ID
2-s2.0-84897950584 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
The goal of perioperative monitoring is to aid the clinician in optimizing care to achieve the best possible survival with the lowest possible morbidity. Ideally, we would like to have monitoring that can rapidly and accurately identify perturbations in circulatory well-being that would permit timely intervention and allow for restoration before the patient is damaged. The evidence to support the use of our standard monitoring strategies (continuous electrocardiography, blood pressure, central venous pressure, oxygen saturation and capnography) is based on expert opinion, case series, or at best observational studies. While these monitoring parameters will identify life-threatening events, they provide no direct information concerning the oxygen economy of the patient. Nevertheless, they are mandated by professional societies representing specialists in cardiac disease, critical care, and anesthesiology. Additional non-routine monitoring strategies that provide data concerning the body's oxygen economy, such as venous saturation monitoring and near infrared spectroscopy, have shown promise in prospective observational studies in managing these complex groups of patients. Ideally, high-level evidence would be required before adopting these newer strategies, but in the absence of new funding sources and the challenges of the wide variation in practice patterns between centers, this seems unlikely. The evidence supporting the current standard perioperative monitoring strategies will be reviewed. In addition, evidence supporting non-routine monitoring strategies will be reviewed and their potential for added benefit assessed.
Author List
Tweddell JS, Ghanayem NS, Hoffman GMAuthor
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Critical CareHeart Defects, Congenital
Hemodynamics
Humans
Intraoperative Complications
Monitoring, Physiologic
Postoperative Complications
