Table 2 Options to optimize perioperative hemodynamic management in high-risk patients

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Reactive

Correct hypotension, tachycardia.

Give fluids in the presence of suspected hypovolemia with increased pulse pressure variation (PPV), systolic pressure variation, stroke volume variation (SVV), or pleth variability index (PVI).

Identify a reduction in cardiac output and react promptly with fluid challenge.

Identify a reduction in central venous oxygen saturation (ScvO₂) and react promptly with fluid challenge.

▪

Pro-active

Maintain arterial pressure and heart rate within acceptable ranges.

Maximize stroke volume.

Maintain PPV or SVV at less than 12% or PVI at less than 14%.

Maintain cardiac index (CI) or oxygen delivery (DO₂) in a desired range (for example, CI of more than 4.5 L/minute/m² and DO₂ of more than 600 mL/minute/m²).

Maintain ScvO₂ at more than 65%.