Renner Jochen, Grünewald Matthias, Bein Berthold
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Department of Anaesthesiology and Intensive Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
Best Pract Res Clin Anaesthesiol. 2016 Jun;30(2):201-16. doi: 10.1016/j.bpa.2016.04.006. Epub 2016 May 5.
Over the past decades, there has been considerable progress in the field of less invasive haemodynamic monitoring technologies. Substantial evidence has accumulated, which supports the continuous measurement and optimization of flow-based variables such as stroke volume, that is, cardiac output, in order to prevent occult hypoperfusion and consequently to improve patients' outcome in the perioperative setting. However, there is a striking gap between the developments in haemodynamic monitoring and the increasing evidence to implement defined treatment protocols based on the measured variables, and daily clinical routine. Recent trials have shown that perioperative morbidity and mortality is higher than anticipated. This emphasizes the need for the anaesthesia community to address this issue and promotes the implementation of proven concepts into clinical practice in order to improve patients' outcome, especially in high-risk patients. The advances in minimally invasive and non-invasive monitoring techniques can be seen as a driving force in this respect, as the degree of invasiveness of any monitoring tool determines the frequency of its application, especially in the operating room (OR). From this point of view, we are very confident that some of these minimally invasive and non-invasive haemodynamic monitoring technologies will become an inherent part of our monitoring armamentarium in the OR and in the intensive care unit (ICU).
在过去几十年中，微创血流动力学监测技术领域取得了显著进展。大量证据已经积累起来，支持持续测量和优化基于流量的变量，如每搏量，即心输出量，以防止隐匿性低灌注，从而改善围手术期患者的预后。然而，血流动力学监测的发展与基于测量变量实施明确治疗方案的越来越多的证据以及日常临床实践之间存在显著差距。最近的试验表明，围手术期发病率和死亡率高于预期。这强调了麻醉学界解决这一问题的必要性，并促进将已证实的概念应用于临床实践，以改善患者的预后，特别是在高危患者中。在这方面，微创和无创监测技术的进步可被视为一种驱动力，因为任何监测工具的侵入程度决定了其应用频率，尤其是在手术室（OR）。从这个角度来看，我们非常有信心，这些微创和无创血流动力学监测技术中的一些将成为我们在手术室和重症监护病房（ICU）监测手段的固有组成部分。
