Haemodynamic monitoring in patients undergoing high-risk surgery: a survey of current practice among anaesthesiologists at the University of the Witwatersrand

Abstract

Background: Haemodynamic monitoring and optimisation in high-risk surgery patients improve postoperative outcomes. High-income countries (HICs) have reviewed their haemodynamic monitoring and management practices. There is, however, a paucity of literature in low- and middle-income countries (LMICs) in this regard. The aim of this study was to describe the current haemodynamic monitoring practice in high-risk surgery patients among anaesthesiologists at the University of the Witwatersrand. 
Methods: A survey was conducted among anaesthesiologists at the University of the Witwatersrand using a convenience sampling method by means of an adapted questionnaire from previous research done on this topic. 
Results: A total of 64 out of 76 questionnaires were analysed, attaining a response rate of 84%. Ninety-seven per cent of the respondents either provided or directly supervised anaesthesia for high-risk surgery patients. Ninety-seven per cent of them frequently monitored invasive arterial blood pressure (IABP), 68.8% monitored stroke volume variation (SVV) and 53% monitored cardiac output (CO). The most frequently optimised parameter was IABP (68.8%); while CO was optimised by only 39.1% of the respondents. The VigileoTM monitor was the most frequently used CO device (84.4%). The main reason for not monitoring CO was the use of dynamic parameters of fluid responsiveness as a surrogate for CO (57.8%). Seventy-five per cent of the respondents used SVV as a diagnostic indicator for volume expansion, but the haemodynamic effects of volume expansion were frequently assessed using change in heart rate (78.1%) and blood pressure (76.6%). Most of the respondents (98.4%) believed that their haemodynamic management practice could be improved. 
Conclusion: Anaesthesiologists at the University of the Witwatersrand frequently monitored and optimised IABP rather than CO in high-risk surgery patients. The respondents used dynamic parameters of fluid responsiveness as a surrogate for CO monitoring and as an indicator for volume expansion. Most of the respondents believed that their current haemodynamic management practice in this setting could be improved.