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Decision Support for Hemodynamic Management: From Graphical Displays to Closed Loop Systems

Michard, Frederic MD, PhD

doi: 10.1213/ANE.0b013e31827e5002
Technology, Computing, and Simulation: Special Article

The way hemodynamic therapies are delivered today in anesthesia and critical care is suboptimal. Hemodynamic variables are not always understood correctly and used properly. The adoption of hemodynamic goal-directed strategies, known to be clinically useful, is poor. Ensuring therapies are delivered effectively is the goal of decision support tools and closed loop systems. Graphical displays (metaphor screens) may help clinicians to better capture and integrate the multivariable hemodynamic information. This may result in faster and more accurate diagnosis and therapeutic decisions. Graphical displays (target screens) have the potential to increase adherence to goal-directed strategies and ultimately improve patients’ outcomes, but this remains to be confirmed by prospective studies. Closed loop systems are the ultimate solution to ensure therapies are delivered. However, most therapeutic decisions cannot be based on a limited number of output variables. Therefore, one should focus on the development of systems designed to relieve clinicians from very simple and repetitive tasks. Whether intraoperative goal-directed fluid therapy may be one of these tasks remains to be evaluated.

Published ahead of print February 28, 2013

From the Department of Critical Care, Edwards Lifesciences, Irvine, California.

Accepted for publication November 02, 2012.

Published ahead of print February 28, 2013

Conflict of Interest: See Disclosures at the end of the article.

Reprints will not be available from the author.

Address correspondence to Frederic Michard, MD, PhD, Critical Care, Edwards Lifesciences, 1 Edwards Way, Irvine, CA. Address e-mail to

© 2013 International Anesthesia Research Society