Perioperative hemodynamic optimization - Adults including obstetrics.

OBJECTIVE

The Société Française d'Anesthesésie et de Réanimation (SFAR) (French Society for Anaesthesia and Intensive Care) is proposing a set of guidelines for perioperative hemodynamic optimisation.

DESIGN

A committee of 27 experts was set up. Policy of declaring and monitoring links of interest was applied and respected throughout the process of producing the reference system. Similarly, it did not receive any funding from a company marketing a health product (drug or medical device). The committee had to respect and follow the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) method to assess the quality of the evidence on which the guidelines were based.

METHODS

The latest SFAR guidelines on perioperative intravascular fluid loading strategy were published in 2012. We wished to update these guidelines after analysing the literature using GRADE® methodology, identifying 5 major fields: arterial pressure, systolic ejection volume and dynamic indices, tissue perfusion indices, volume expansion (excluding transfusion) and/or vasopressors and/or inotropes, and economic impact. Each question was formulated using the PICO (Patients, Intervention, Comparison, Outcome) format.

RESULTS

The experts' summary work and the application of the GRADE method resulted in 24 guidelines. Among the guidelines, 2 have a high level of evidence (GRADE 1) and 8 a low level of evidence (GRADE 2). As the GRADE method could not be applied to 8 questions, the guidelines were based on expert opinion. It was not possible to reach a decision on 6 other questions.

CONCLUSION

24 guidelines on perioperative haemodynamic optimization have been formulated, with a high degree of agreement between experts.