MiCo, Chemin de Chapallaz 4, Denens, Switzerland.
Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794-8480, USA.
Br J Anaesth. 2017 Jul 1;119(1):31-39. doi: 10.1093/bja/aex140.
Enhanced recovery programmes (ERPs) are increasingly used to improve post-surgical recovery. However, compliance to various components of ERPs-a key determinant of success-remains sub-optimal. Emerging technologies have the potential to help patients and caregivers to improve compliance with ERPs.Preoperative physical condition, a major determinant of postoperative outcome, could be optimized with the use of text messages (SMS) or digital applications (Apps) designed to facilitate smoking cessation, modify physical activity, and better manage hypertension and diabetes. Several non-invasive haemodynamic monitoring techniques and decision support tools are now available to individualize perioperative fluid management, a key component of ERPs. Objective nociceptive assessment may help to rationalize the use of pain medications, including opioids. Wearable sensors designed to monitor cardio-respiratory function may help in the early detection of clinical deterioration during the postoperative recovery and to address 'failure to rescue'. Activity trackers may be useful to monitor early mobilization, another major element of ERPs. Finally, electronic checklists have been developed to ensure that none of the above-mentioned ERP elements is omitted during the surgical journey.By optimizing compliance to the multiple components of ERPs, digital innovations, non-invasive techniques and wearable sensors have the potential to magnify the clinical and economic benefits of ERPs. Among the growing number of technical innovations, studies are needed to clarify which tools and solutions have real clinical value and are cost-effective.
加速康复方案（ERP）越来越多地被用于改善术后恢复。然而，ERP 各个组成部分的依从性——成功的关键决定因素——仍然不理想。新兴技术有可能帮助患者和护理人员提高对 ERP 的依从性。术前身体状况是术后结果的主要决定因素，可以通过使用旨在促进戒烟、改变身体活动以及更好地控制高血压和糖尿病的短信（SMS）或数字应用程序（Apps）来优化。现在有几种非侵入性血流动力学监测技术和决策支持工具可用于个体化围手术期液体管理，这是 ERP 的一个关键组成部分。客观疼痛评估可能有助于合理使用止痛药，包括阿片类药物。旨在监测心肺功能的可穿戴传感器可帮助在术后恢复期间及早发现临床恶化，并解决“救援失败”问题。活动追踪器可能有助于监测早期动员，这是 ERP 的另一个主要组成部分。最后，开发了电子检查表，以确保在手术过程中不会遗漏上述任何 ERP 要素。通过优化对 ERP 多个组成部分的依从性，数字创新、非侵入性技术和可穿戴传感器有可能放大 ERP 的临床和经济效益。在越来越多的技术创新中，需要进行研究以明确哪些工具和解决方案具有真正的临床价值和成本效益。
