1 rich Libsyn https://www.libsyn.com 90 600 At the Evidence-Based Perioperative Medicine (EBPOM) World Congress in London, Andy Cumpstey interviews Mike Grocott, Professor of Anaesthesia and Critical Care Medicine at the University of Southampton and consultant in critical care medicine at University Hospital Southampton NHS Foundation Trust and Nikolai Bang-Foss, Professor, Chair in Acute Perioperative Medicine and Pathophysiology at the University of Copenhagen and Consultant &amp;amp; Head of Department of gastrointestinal and orthopaedic anaesthesia at Copenhagen University Hospital The discussion comes after a hemodynamic therapy debate on fluid and blood pressure management. Grocott argues that while clinicians aim to optimize circulating volume, tissue perfusion, and avoid fluid overload, current monitoring makes these goals difficult and evidence for goal-directed fluid/hemodynamic therapy is mixed; low flow/pressure is harmful but raising them doesn’t reliably improve outcomes. Foss emphasizes that vasoconstrictors can normalize blood pressure without improving flow or organ perfusion and that preload responsiveness is not a marker of hypovolemia because it can reflect vasoplegia. He proposes using the peripheral perfusion index (PI) from standard pulse oximeter plethysmography as a real-time surrogate of perfusion, citing associations between low PI (e.g., &amp;lt;1.5, especially &amp;lt;0.5) and increased mortality and acute kidney injury, and describes clinical examples where small fluid boluses increased PI despite stable blood pressure and stroke volume. TopMedTalk https://www.topmedtalk.com <iframe title="Libsyn Player" style="border: none" src="//html5-player.libsyn.com/embed/episode/id/43713344/height/90/theme/custom/thumbnail/yes/direction/forward/render-playlist/no/custom-color/3a5fa9/" height="90" width="600" scrolling="no" allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen></iframe> https://assets.libsyn.com/secure/content/208761139