Browsing by Subject "Central Venous Pressure"
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Item Open Access Commentary: How to avoid early Fontan failure?(The Journal of thoracic and cardiovascular surgery, 2021-04) Mizrahi, Michelle; Beckerman, ZivItem Open Access Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)(Canadian Journal of Anesthesia, 2016-01-01) Miller, Timothy Ellis; Roche, Anthony Michael; Mythen, Michael GerardOptimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a “zero-balance” approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and “permissive oliguria” could be tolerated.Item Open Access Poor adoption of hemodynamic optimization during major surgery: are we practicing substandard care?(Anesth Analg, 2011-06) Miller, Timothy E; Roche, Anthony M; Gan, Tong JItem Open Access Respiratory Variation in Central Venous Pressure (CVP) to Guide Ventilatory Support in Coronavirus Disease 2019 (COVID-19)-Related Lung Injury.(Journal of cardiothoracic and vascular anesthesia, 2021-01) La Colla, Luca; Bronshteyn, Yuriy S; Mark, Jonathan B