CME: Economic Burden of Postoperative Complications: Would Perioperative Goal Directed Therapy Help?

ACCREDITATION EXPIRED: November 12, 2017

Activity Description / Statement of Need:

Fluid administration is a cornerstone of perioperative care, with the ultimate goal being the maintenance of intravascular volume in a fashion that incurs the fewest complications. There is a wide spectrum of risk inherent in different perioperative fluid managements strategies. On one hand, failing provoke a shunting of what intravascular volume remains away from the so-called “nonvital” organs to organs such as the brain and the heart. Clinical manifestations of under-resuscitation include postoperative complications ranging from the inconvenient and unpleasant (e.g., dizziness and post-operative nausea and vomiting) to those that acutely complicate the course of care such as: acute kidney injury and impaired wound healing as a result of inadequate blood flow to surgical anastamoses. On the other hand, over-resuscitation engenders risks such as pulmonary edema and its ensuing complications like impairment of pulmonary function, post-operative coagulopathy, abdominal compartment syndrome, gastrointestinal edema, impaired tolerance to enteral feeding, and increased bacterial translocation from the gut, which may in turn increase the risk of systemic inflammatory response syndromes and multiorgan system dysfunction.

Conventionally, perioperative fluid management methodology has entailed a “recipe book” or one-size-fits all approach that emphasizes settling on a continuous rate of fluid administration and replacing additional losses only as they occur. That strategy has come under fire for its failure to take a number of variables into account, including: preoperative fluid status, challenges relating to accurate measurement of intraoperative fluid loss, and perioperative variations in cardiac function and vascular tone. Thus, the medical literature is rife with studies, not to mention opinion, debating the merits of liberal versus restrictive fluid management strategies in populations ranging from orthopedic to intraabdominal surgeries. In the end, reviews of the literature and recent studies have begun to argue in favor of an adaptable approach that emphasizes specific patient population and surgical types in addition to moment-to-moment intraoperative fluid and pressure estimates and measurements aiding conventional decision drivers intraoperatively.

Dr. Manecke discusses the economic burden of complications of surgery and how perioperative goal-directed therapy may provide some opportunities to optimize practice in and around the clinical experience of the operating room setting.

Agenda

• Surgical complications, measured in quality and numbers
• The dangers represented by sodium and hyper- and hypovolemia
• Enhanced recovery after surgery (ERAS) in a snapshot
• Perioperative goal-directed therapy (PDGT) in a snapshot
• PDGT: does it work? What does the literature have to say?
• Components of the ideal PDGT algorithm
• A sample PDGT algorithm

Target Audience:

This program has been designed for a multidisciplinary physician and nurse audience including: ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care

This program is supported by Educational Grants from Edwards Lifesciences.

Release Date: September 12, 2015 -- Expiration Date: November 12, 2017

Faculty: Gerald Manecke Jr., MD

Agenda

Learning Objectives

Accreditation

Faculty Disclosure and Resolution of COI

Instructions

System Requirements