Optimising the perioperative patient
The Oxygen Reserve Index: A new paradigm in monitoring oxygenation
The oxygen reserve index (ORI) is a new development in multiple wavelength pulse oximetry that reflects, in real-time and non-invasively, the oxygenation status in the moderate hyperoxic range in patients receiving supplemental oxygen.
ORI may provide an early warning when arterial oxygenation deteriorates before any changes in SpO2 occur.
The ORI may provide information regarding the patient’s initial response to acute oxygen therapy.
High O2 in critical care and Perioperative med has been shown to be deleterious
Many studies shown that hyperoxia is prevalent in care.
ORI could help to limit O2 exposure?
We put FiO2 higher as we are afraid of hypoxaemia
ORI could be used to minimise FiO whilst maintaining good SpO2 and could unmask the effects of PEEP titration-could help to detect overdistension
Scheeren, T.W.L., Belda, F.J. & Perel, A. J Clin Monit Comput (2017). https://doi.org/10.1007/s10877-017-0049-4
Goal directed fluid restriction
Perioperative fluid therapy should follow the ERAS principles. Instead, in the US 25% of the patients kept too dry and 25% of them are kept too wet.
Keeping patients very negative risks the development of AKI postoparetively.