Perioperative Metabolic and Hemodynamic Changes in Adults and Children

Traditional postoperative monitoring has focused on physiologic and biochemical deficiencies that are identified and corrected. This approach assumes that normal values for age are appropriate therapeutic goals, but does not take into account the increased or altered metabolic and hemodynamic needs of critically ill postoperative patients. Dehydration, hypoxemia, hypotension, hypovolemia, and oliguria are usually corrected, sometimes overcorrected, most frequently on one-at-a-time search for deficiencies. Unfortunately, in adults [1, 2] and children [3, 4] the most commonly measured variables like blood pressure and heart rate are the poorest, least relevant predictors of outcome [1]. Cardiac index, pulmonary vascular resistance, oxygen delivery (DO2) and consumption (VO2) have a better prognostic significance, but in general no single variable is satisfactory, confirming that postoperative monitoring requires a multi-factorial approach [1, 3].