The JAMA Network Journals recently published a health informatics study which points out the benefit of using a cardiac-output guided intervention to be able to control and improve hemodynamics, which includes blood flow and pressure, peri-operative and post-operatively in patients who underwent high risk gastrointestinal surgery.
Each year, nearly 230 million patients worldwide undergo surgery, and between 1% and 4% of these patients do not survive the procedure. High-risk patients, those who are older and have comorbidities and those who undergo major surgeries in the gastrointestinal and cardiac regions, experience the most complications and mortalities.
Although it is well established that IV fluids and drugs which increase the heart muscle’s contractility are vital in managing patients, particularly those who have had major gastrointestinal surgery, it is rather observed that there is no specific guideline which practitioners follow in using these drugs. These medications were prescribed and ordered subjectively, thus varying clinical practice and patient outcomes.
In lieu of this, it was suggested in a health informatics research that therapy and management must be based on a hemodynamic guide or algorithm. The latter is a step-by-step protocol which is commonly used by health practitioners to manage common illnesses and diseases. It was also suggested to have cardiac output monitoring integrated within the algorithm. The U.S. Centers for Medicare & Medicaid Services and by the UK National Institute for Health and Care Excellence advocates the use of hemodynamic therapy algorithms.
The present study, led by health informatics researcher Rupert M. Pearse, M.D., of Queen Mary University of London, was conducted by allocating patients who are aged 50 years older to two groups. The first group who had 366 participants received the usual care and the second was assigned a cardiac output-guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery which had 368 participants. Both groups are undergoing major gastrointestinal sugery.
The results of the study were previously deemed not significant. However, when the study was included in a systematic review of similar trials, the findings showed beneficial effects on the mortality rate of the patients.
The team explains that the study is mainly targeted on addressing the limitations of the previous study. Additionally, they said that this research is “the largest trial of a perioperative, cardiac output-guided hemodynamic therapy algorithm to date.”