8Assessing volume status and fluid responsiveness in critical care
01 Oct 2018
Although insufficient and excessive resuscitation are both associated with worse clinical outcomes, most decisions regarding fluid therapy are still made empirically.
The quintessential questions in fluid resuscitation are what the current state of the patient’s intravascular volume is and whether the patient’s physiological variables will improve if he/she receives continued fluid resuscitation or a fluid bolus?
7Smoking and surgery
08 Mar 2018
Smoking prevalence is decreasing but remains common: in 2014 17% of adults were current smokers compared to 50% in 1974 (Action on Smoking and Health, 2017). As smoking is conclusively harmful, acute care providers are advised to provide support and advice for smoking cessation (NICE, 2013). Preoperative clinics offer an opportunity to modify patient behaviour prior to surgery.
6Postoperative cognitive dysfunction
08 Jun 2018
Some patients emerge from surgery and anaesthesia with noted deficits in cognitive function that were not present preoperatively. This cognitive impairment – postoperative cognitive dysfunction – is a recognized clinical phenomenon in patients undergoing major cardiac and non-cardiac surgery (Rundshagen, 2014). It represents a decline in neuropsychological domains including memory, executive functioning and speed of processing (Tsai et al, 2010).
5Cardiopulmonary Exercise Testing
08 April 2018
Cardiopulmonary exercise testing is a non-invasive test providing objective information about the cardiovascular, pulmonary and muscle function under physiological stress and the ability to deliver oxygen to peripheral tissues (Wasserman et al, 2004). Increasingly cardiopulmonary exercise testing is being used for preoperative risk assessment and to enable shared decision-making conversations with patients (Huddart et al, 2013).
4The Perioperative Quality Improvement Programme: improving outcomes
12 Feb 2018
The Perioperative Quality Improvement Programme has been set up as a multidisciplinary initiative to look at the quality of care and outcomes of patients undergoing major surgery in the NHS. Its aim is to reduce variation while effecting an overall improvement in morbidity.