Improving the acute and perioperative hemodynamic assessment

Kaufmann, T., 2020, [Groningen]: University of Groningen. 203 p.

Research output: ThesisThesis fully internal (DIV)

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First, this thesis aimed to extend the evidence on the applicability of hemodynamic monitoring during the perioperative period and after admission to the ICU. Second, we aimed to gain knowledge on how to improve the conduct of studies in perioperative and critical care medicine.

We provided an overview of the current evidence for hemodynamic monitoring in perioperative goal-directed therapy. We showed that the studies on this subject showed clinical heterogeneity and risk of bias. Extension of all aspects of hemodynamic monitoring was considered in this thesis. A study was performed on the educated guess of physicians when estimating cardiac output using clinical examination to help improve the reliability of the clinical examination. We showed that physicians at the bed-side mainly consider mottling score and norepinephrine dose when estimating cardiac output. In another study, we demonstrated that blood pressure measurements differ when measured invasively or non-invasively and that these differences may have clinical consequences. We also showed that echocardiography could be performed by novices, but experts are needed to interpret obtained images. We demonstrated that cardiac output measurements vary in critically ill patients when measured with echocardiography or uncalibrated pulse wave analysis.

For the second part of this thesis, we demonstrated that various mortality prediction models exist for critically ill patients. Quality of methodology often lacks for these models, and improvements have to be made to help patient care. To help improve the quality of studies, we finally propose that study protocols are prepublished and made available for peer-review before conduct.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Scheeren, Thomas, Supervisor
  • Horst, van der, Iwan, Supervisor
  • Bakker, J., Assessment committee, External person
  • Buhre, Wolfgang F., Assessment committee, External person
  • van der Voort, P.H.J., Assessment committee, External person
Award date8-Jul-2020
Place of Publication[Groningen]
Print ISBNs9789403426983
Electronic ISBNs9789403426990
Publication statusPublished - 2020

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