PerioperativeOptimisation+oxygendelivery.pptVIP

Perioperative Optimisation + oxygen delivery Rob Stephens PACU Study Day Feb 22 2010 Contents High risk surgery O2 O2 delivery + consumption Postoperative physiology Postoperative O2 delivery + consumption ‘Optimisation’ POM-O Optimize The High Risk Patient Perioperative mortality is 1%, but increased to 33% in the high risk patient High risk patients account for only 12.5% of surgical procedures, but also of 80% postoperative deaths 15% of these patients were admitted to ICU Scoring systems can help identify patients who are at high risk of postoperative morbidity and mortality Patient Procedure Patient factors; eg ASA Score 1 A normal healthy person 2 A patient with mild systemic disease 3 A patient with severe systemic disease that is not incapacitating 4 A patient with incapacitating disease that is a constant threat to life 5 A moribound patient who is not expected to live 24 hours with or without surgery E An emergency operation Combined scores; eg RCRI High-risk surgery i.e., intraperitoneal, intrathoracic, vascular Coronary artery disease Congestive heart failure History of cerebrovascular disease Insulin treatment for diabetes mellitus Preoperative serum creatinine level 180 μmoL Procedure Factors Body cavity entered eg laparotomy Blood loss Length of procedure Emergency/urgent vs elective/scheduled Oxygen needed for cells to perform ‘work’ + live only a few seconds of stored 02 surgery causes cells to need more 02 early- immediately postoperative phase ….Do patients that can give their cells more 02 ?do better Oxygen Delivery DO2 The amount of oxygen delivered to the tissues per minute DO2 1.34 x Hb x SaO2 100 DO2 HR x SV x 1.34 x Hb x SaO2 100 Oxygen Consumption VO2 Total amount of oxygen consumed /taken up by the tissues per minute VO2 CO x CaO2 – CvO2 OER VO2 CI CO/body surface Oxygen extraction ratio DO2 area Oxygen Consumption VO2 Total amount of oxygen consumed or taken up by the tissues