Hemodynamic Management

Résumé fourni par la source

In order to prevent oxygen debt and improve outcome, it is necessary to maintain adequate tissue oxygenation. This is accomplished by optimizing oxygen transport balance, i.e., by maximizing oxygen delivery while minimizing oxygen consumption. One of the major priorities intra- and postoperatively is the prevention and early treatment of low cardiac output syndrome. Most commonly, this is achieved using phosphodiesterase type 3 inhibitors. Although catecholamines are effective in more severe cases, they increase the myocardial oxygen demand, which limits their use in the setting of cardiac surgery. Furthermore, their effects vary according to the availability of adrenergic receptors. Calcium sensitizers are considered a suitable alternative. Pulmonary vasodilators and management of cardiopulmonary interactions are particularly important when low cardiac output results from the impediment of the pulmonary blood flow. Noninvasive hemodynamic measurements have the most favorable risk/benefit ratio in children, and monitoring of regional saturations might become a central parameter.

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