Hemodynamic optimization in perioperative- and intensive care patients: A special focus on blood pressure management

Research output: PhD ThesisPhd-Thesis - Research and graduation internal

Abstract

This dissertation focusses on the hemodynamic optimization of perioperative and intensive care patients, with special attention to blood pressure.
Part I examines the definition and management of hypotension, and its association with morbidity and mortality. A high variability in threshold definitions of hypotension is found in the literature. However, we found one and the same definition is being used in most ICU’s worldwide, regardless of patient category. ICU physicians and nurses indicated that hypotension occurs in most patients, and is an underdiagnosed and largely preventable phenomenon. In most ICU’s, no protocol to treat hypotension is available, and more than half of the respondents indicated preferring to have one in the future. In a systematic review, we show exposure to hypotension during surgery increases the risk of morbidity and mortality, and that progressive severity of the hypotension threshold used in studies resulted in increasing strength of associations.
Part II focuses on the prediction and optimization of hemodynamic changes. We show that the intraoperative employment of an algorithm predicting hypotension, combined with proactive treatment guidance, results in a reduction in the amount of intraoperative hypotension. Moreover, it might also reduce the total percentage of time spent in hypotension after surgery, indicating a potential vicious circle of hemodynamic instability. Finally, we investigated whether a difference in immediate hemodynamic response following transcatheter aortic valve implantation could be predictive for differences in outcome. We found that a larger immediate reduction in left ventricular ejection time resulted in greater increase in health related quality of life.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Amsterdam
Supervisors/Advisors
  • Hollmann, Markus, Supervisor
  • Vlaar, Alexander, Supervisor
  • Veelo, Denise, Co-supervisor
  • Immink, Rogier, Co-supervisor
Award date2 Feb 2023
Print ISBNs9789464196771
Publication statusPublished - 2023

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