# Current Practices of Haemodynamic Monitoring in High-Risk Surgical Patients: A Nationwide Survey Among Malaysian Anaesthesiologists

## TL;DR

This study surveys Malaysian anaesthesiologists to understand current haemodynamic monitoring practices in high-risk surgeries and identifies areas for improvement.

## Contribution

The study provides a nationwide assessment of haemodynamic monitoring practices in Malaysia and highlights disparities in monitoring techniques across healthcare settings.

## Key findings

- Only 15.7% of participants had access to written protocols for haemodynamic management.
- Transthoracic echocardiography is the most commonly used tool for high-risk surgical patients.
- Advanced monitoring parameters are predominantly used in university hospitals.

## Abstract

Background: Advanced haemodynamic monitoring has been recommended for use in high-risk surgeries and high-risk patients undergoing surgery. This study aims to assess the current practices of haemodynamic monitoring in high-risk surgical patients among Malaysian anaesthesiologists. Methodology: This is a cross-sectional survey among Malaysian anaesthesiologists, following approval from the institution’s Medical Research Ethics Committee and the National Medical Research Register. The survey utilised a questionnaire developed by Cannesson et al. to gather demographic data, practice information, and haemodynamic monitoring practices. Statistical analysis was performed using SPSS, and results were presented as the mean, median, or frequency as appropriate. Results: A total of 366 participants responded to the questionnaire, and 2 dropped out due to an incomplete form. This study found differences in the frequency of haemodynamic optimisation and monitoring techniques used in different healthcare settings. Written protocols or statements concerning haemodynamic management in high-risk surgical cases were only available to 15.7% of participants in the institution. The overall utilisation rate of cardiac output monitoring was found to be 31.1%, with a significant majority of the usage observed in university hospitals (p < 0.001). Central venous pressure was more commonly used in university hospitals and private hospitals compared to public hospitals (p < 0.001). The usage of advanced parameters such as stroke volume variation, cardiac index, and systemic vascular resistance was significantly higher in university hospitals, with a p value < 0.001. Transthoracic echocardiography was the most common tool used for high-risk surgical patients. The primary reasons for participants not utilising cardiac output monitoring include the lack of availability of such monitoring in their respective settings, which constitutes 66.9% of the respondents. The overwhelming majority of participants, namely 98%, expressed the belief that there is room for improvement in their present haemodynamic care. Conclusions: This study offers significant insights into the prevailing haemodynamic monitoring practices employed by Malaysian anaesthesiologists in the context of high-risk surgical patients. The findings have the potential to contribute to future educational initiatives and establish practice standards for haemodynamic monitoring in high-risk surgical procedures.