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Medicina
Special Issues
Evolving Concepts in Hemodynamic Management
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Evolving Concepts in Hemodynamic Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 8855

Special Issue Editors

Prof. Dr. Zsolt Molnar

E-Mail Website
Guest Editor
Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
Interests: perioperative hemodynamic stabilization; oxygen debt; inflammatory biomarkers; lung recruitment; blood purification; fluid therapy
Prof. Dr. Xavier Monnet

E-Mail Website
Guest Editor
Bicêtre Hospital Paris-South University Hospitals, Paris, France
Interests: fluid resuscitation; fluid responsiveness; hemodynamic monitoring

Special Issue Information

Dear Colleagues,

Personalized medicine is becoming a widely accepted concept in future critical care and perioperative medicine. Hemodynamic management, one of the most important measures of resuscitation, has a huge impact on outcomes. It can be lifesaving, but only if it is delivered in an adequate manner. Fluid management and vasoactive support are the most important components of hemodynamic therapy, but both are double-edged swords. Over- and under-resuscitation can have similar adverse effects leading to unfavorable outcomes. Therefore, individualizing and conceptualizing hemodynamic management are mandatory. However, personalizing therapy is not easy. It requires a multimodal approach and sometimes the use of invasive hemodynamic monitoring. Recently, due to evolving technology, less invasive and non-invasive alternatives have appeared on the market. However, validating these devices and defining the patient populations in which they can be used as reliable alternatives to the invasive gold standard remain challenging. Translating all the information within this multimodal concept into clinical decision making requires intensive training and a lot of practice. Will artificial intelligence help us in the future? Most likely, the answer is yes. This Special Issue, “Evolving Concepts in Hemodynamic Management”, will focus on these topics in chapters written by internationally acknowledged experts in the field.

Prof. Dr. Zsolt Molnar
Prof. Dr. Xavier Monnet
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • personalized medicine
  • hemodynamic management
  • circulatory shock
  • fluid resuscitation
  • vasoactive support
  • artificial intelligence

Published Papers (3 papers)

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Research

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13 pages, 2282 KiB  
Article
Impact of Albumin Binding Function on Pharmacokinetics and Pharmacodynamics of Furosemide
by Gerd Klinkmann, Sebastian Klammt, Malte Jäschke, Jörg Henschel, Martin Gloger, Daniel A. Reuter and Steffen Mitzner
Medicina 2022, 58(12), 1780; https://doi.org/10.3390/medicina58121780 - 2 Dec 2022
Cited by 7 | Viewed by 3222
Abstract
Background and Objectives: Albumin binding of the loop diuretic furosemide forms the basis for its transport to the kidney and subsequent tubular secretion, which is a prerequisite for its therapeutic effects. Accordingly, high albumin concentrations should result in higher efficacy of furosemide. [...] Read more.
Background and Objectives: Albumin binding of the loop diuretic furosemide forms the basis for its transport to the kidney and subsequent tubular secretion, which is a prerequisite for its therapeutic effects. Accordingly, high albumin concentrations should result in higher efficacy of furosemide. However, study results on the combination of furosemide in conjunction with albumin, and on the efficacy of furosemide in hypoalbuminemia, did not confirm this hypothesis. The aim of this study was to determine the efficacy of furosemide not only in relation to albumin concentration, but also taking albumin function into account. Materials and Methods: In a prospective and non-interventional clinical observational trial, blood and urine samples from 50 intensive care patients receiving continuous intravenous furosemide therapy were evaluated. Albumin binding capacity (ABiC) determination allowed conclusions to be drawn about the binding site-specific loading state of albumin, by quantifying the unbound fraction of the fluorescent marker dansylsarcosine. In addition, assessment of the total concentration of furosemide in plasma and urine, as well as the concentration of free furosemide fraction in plasma, was performed by HPLC–MS. The efficacy of furosemide was evaluated by the ratio of urine excretion to fluid intake. Results: In patients with an ABiC ≥ 60% free furosemide fraction was significantly lower compared to patients with a lower ABiC (p < 0.001), urinary furosemide concentration was higher (p = 0.136), and a significantly higher proportion of infused furosemide was excreted renally (p = 0.010). ABiC was positively correlated (r = 0.908, p = 0.017) with increase in the urine excretion to fluid input ratio after initiation of furosemide therapy. Conclusions: ABiC could serve as a marker for individual response to furosemide and could be used to generate patient-specific therapeutic regimens. In view of the relatively low number of patients in this study, the relationship between furosemide efficacy and albumin function should be investigated in larger studies in the future. Full article
(This article belongs to the Special Issue Evolving Concepts in Hemodynamic Management)
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Review

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10 pages, 799 KiB  
Review
Continuous Blood Pressure Monitoring in Patients Having Surgery: A Narrative Review
by Alina Bergholz, Gillis Greiwe, Karim Kouz and Bernd Saugel
Medicina 2023, 59(7), 1299; https://doi.org/10.3390/medicina59071299 - 14 Jul 2023
Cited by 1 | Viewed by 2296
Abstract
Hypotension can occur before, during, and after surgery and is associated with postoperative complications. Anesthesiologists should thus avoid profound and prolonged hypotension. A crucial part of avoiding hypotension is accurate and tight blood pressure monitoring. In this narrative review, we briefly describe methods [...] Read more.
Hypotension can occur before, during, and after surgery and is associated with postoperative complications. Anesthesiologists should thus avoid profound and prolonged hypotension. A crucial part of avoiding hypotension is accurate and tight blood pressure monitoring. In this narrative review, we briefly describe methods for continuous blood pressure monitoring, discuss current evidence for continuous blood pressure monitoring in patients having surgery to reduce perioperative hypotension, and expand on future directions and innovations in this field. In summary, continuous blood pressure monitoring with arterial catheters or noninvasive sensors enables clinicians to detect and treat hypotension immediately. Furthermore, advanced hemodynamic monitoring technologies and artificial intelligence—in combination with continuous blood pressure monitoring—may help clinicians identify underlying causes of hypotension or even predict hypotension before it occurs. Full article
(This article belongs to the Special Issue Evolving Concepts in Hemodynamic Management)
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9 pages, 549 KiB  
Review
Intraoperative Hypotension Prediction—A Proactive Perioperative Hemodynamic Management—A Literature Review
by Jakub Szrama, Agata Gradys, Tomasz Bartkowiak, Amadeusz Woźniak, Krzysztof Kusza and Zsolt Molnar
Medicina 2023, 59(3), 491; https://doi.org/10.3390/medicina59030491 - 2 Mar 2023
Cited by 1 | Viewed by 2825
Abstract
Intraoperative hypotension (IH) is a frequent phenomenon affecting a substantial number of patients undergoing general anesthesia. The occurrence of IH is related to significant perioperative complications, including kidney failure, myocardial injury, and even increased mortality. Despite advanced hemodynamic monitoring and protocols utilizing goal [...] Read more.
Intraoperative hypotension (IH) is a frequent phenomenon affecting a substantial number of patients undergoing general anesthesia. The occurrence of IH is related to significant perioperative complications, including kidney failure, myocardial injury, and even increased mortality. Despite advanced hemodynamic monitoring and protocols utilizing goal directed therapy, our management is still reactive; we intervene when the episode of hypotension has already occurred. This literature review evaluated the Hypotension Prediction Index (HPI), which is designed to predict and reduce the incidence of IH. The HPI algorithm is based on a machine learning algorithm that analyzes the arterial pressure waveform as an input and the occurrence of hypotension with MAP <65 mmHg for at least 1 min as an output. There are several studies, both retrospective and prospective, showing a significant reduction in IH episodes with the use of the HPI algorithm. However, the level of evidence on the use of HPI remains very low, and further studies are needed to show the benefits of this algorithm on perioperative outcomes. Full article
(This article belongs to the Special Issue Evolving Concepts in Hemodynamic Management)
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