Clinical practice in intraoperative haemodynamic monitoring in Poland: A point prevalence study in 31 Polish hospitals

Abstract

Background: Appropriate use of haemodynamic monitoring tools facilitates the adjustment of management to the patient's individual needs. The aim of the study was to evaluate clinical practice in intraoperative monitoring of patients undergoing noncardiac surgical procedures in selected hospitals in Poland. Methods: A point prevalence cross-sectional study was carried out among 587 adult patients of 31 Polish hospitals on April 5th, 2018. The method of monitoring in relation to the estimated individual risk as well as to the type and mode of surgery was analysed. In addition, intraoperative fluid therapy and use of catecholamines were evaluated. Results: Basic monitoring based on non-invasive arterial blood pressure measurements was implemented in 562 (96%) patients. More advanced methods of monitoring were used in 25 (4%) patients during moderate- (n = 16) and high-risk (n = 9) procedures, predominantly in high-risk patients (n = 16) and in university hospital settings (n = 21). Patients monitored basically received significantly higher amounts of fluids, i.e. 8.7 (IQR 6.1-12.6) vs. 6.1 (IQR 4.1-8.6) mL kg-1 h-1, respectively (P < 0.001). The most common vasoactive and inotropic drug was ephedrine, administered to 143 (24%) study patients in a dose of 15 mg (IQR 10-25) - without inter-group differences in categories of individual and procedure-related risk. Conclusions: The basic method of haemodynamic monitoring used in the study population was based on non-invasive arterial blood pressure measurements. The advanced tools of intraoperative haemodynamic monitoring were seldom used. Monitoring was not tailored to the perioperative risk.