title: A web-based Italian survey of current trends, habits and beliefs in hemodynamic monitoring and management.
abstract: Significant evidence outlines that the management of the high-risk surgical patient with perioperative hemodynamic optimization leads to significant benefits. This study aimed at studying the current practice of hemodynamic monitoring and management of Italian anesthesiologists. An invitation to participate in a web-based survey was published on the web site of the Società Italiana di Anestesia Analgesia Rianimazione Terapia Intensiva. Overall, 478 questionnaires were completed. The most frequently used monitoring techniques was invasive blood pressure (94.1 %). Cardiac output was used in 41.3% of the cases mainly throughout less-invasive methods. When cardiac output was not monitored, the main reason given was that other surrogate techniques, mainly central venous oxygen saturation (40.5%). Written protocols concerning hemodynamic management in high-risk surgical patients were used by the 29.1% of the respondents. 6.3% of the respondents reported not to be aware if such document was available at their institution. 86.3% of the respondents reported that they usually optimize high risk patients but to use blood flow assessment rarely (39.7%). The most used parameter in clinical practice to assess the effects of volume loading were an increase in urine output and arterial blood pressure together with a decrease in heart rate and blood lactates. The 45.1% or the respondents outlined that hemodynamic optimization in the high risk patients is of major clinical value. Our study outlines an important gap between available evidence and clinical practice emphasizing the need for a better awareness, more information and knowledge on the specific topic.
authors.affiliation: Liver Transplant Anaesthesia and Critical Care, Azienda Ospedaliera Universitaria Pisana, 56120, Pisa, Italy. g.biancofiore@med.unipi.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Biancofiore
authors.affiliation: Department of Intensive Care Medicine, St George's Hospital, London, UK.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cecconi
authors.affiliation: Department of Anaesthesia and Critical Care, University School of Medicine, Udine, Italy.
authors.forename: Giorgio Della
authors.initials: GD
authors.lastname: Rocca
mesh_terms: D001291:Attitude of Health Personnel; D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data*; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007558:Italy / Q000453:epidemiology; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
keywords: Anesthesia; Goal-directed therapy; Hemodynamics; Perioperative period