ABSTRACT
The pre-optimisation study is outlined. The pre-operative optimisation of high risk elective surgical patients in a District General Hospital is discussed in relation to a research study. Issues related to the development of a protocol are examined. The use of standardised protocols to guide the pre-optimisation process are focused on, emphasising the role of the senior nurse in administering the protocol.
Subject(s)
Clinical Competence , Clinical Protocols , Critical Care/methods , Hemodynamics , Nursing Assessment/methods , Nursing Staff , Preoperative Care/methods , Preoperative Care/nursing , Clinical Nursing Research , Decision Trees , Humans , Nursing Staff/education , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVES: To determine whether preoperative optimisation of oxygen delivery improves outcome after major elective surgery, and to determine whether the inotropes, adrenaline and dopexamine, used to enhance oxygen delivery influence outcome. DESIGN: Randomised controlled trial with double blinding between inotrope groups. SETTING: York District Hospital, England. SUBJECTS: 138 patients undergoing major elective surgery who were at risk of developing postoperative complications either because of the surgery or the presence of coexistent medical conditions. INTERVENTIONS: Patients were randomised into three groups. Two groups received invasive haemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery. Inotropic support was continued during surgery and for at least 12 hours afterwards. The third group (control) received routine perioperative care. MAIN OUTCOME MEASURES: Hospital mortality and morbidity. RESULTS: Overall, 3/92 (3%) preoptimised patients died compared with 8/46 controls (17%) (P=0.007). There were no differences in mortality between the treatment groups, but 14/46 (30%) patients in the dopexamine group developed complications compared with 24/46 (52%) patients in the adrenaline group (difference 22%, 95% confidence interval 2% to 41%) and 28 patients (61%) in the control group (31%, 11% to 50%). The use of dopexamine was associated with a decreased length of stay in hospital. CONCLUSION: Routine preoperative optimisation of patients undergoing major elective surgery would be a significant and cost effective improvement in perioperative care.
