Pre-op Hemodynamic Optimization Index (PHOI) Calculator
- Pre-op Hemodynamic Optimization Index (PHOI): Rationale, Use, and Evidence
The PHOI provided here is a pragmatic composite to help clinicians summarize the patient’s immediate pre-operative hemodynamic state and identify modifiable targets before anesthesia induction. It is not a published or validated score; to our knowledge there is no original “Pre-op Hemodynamic Optimization Index” in the literature. The components and thresholds are grounded in guideline-supported perioperative hemodynamic principles and commonly reported cut-points.
Mean arterial pressure (MAP) — Maintaining MAP ≥65 mmHg intraoperatively is widely recommended to reduce postoperative organ dysfunction.
Heart rate (HR) — Extremes of HR correlate with myocardial oxygen supply–demand imbalance; a pragmatic target of 50–100 bpm is used.
Serum lactate — Lactate reflects global perfusion/oxygen debt; values ≤2 mmol/L are generally considered normal in perioperative/ICU cohorts.
NT-proBNP (optional) — Thresholds near NT-proBNP ≥300 ng/L (and BNP ≥92 ng/L) identify elevated perioperative cardiac risk.
Dynamic preload indices (PPV/SVV; optional) — PPV ≳11–13% or SVV ≳10–12% suggest fluid responsiveness under controlled ventilation.
Vasopressor use — Pre-induction vasopressor requirement indicates hemodynamic vulnerability.
Interpretation: A lower PHOI suggests the patient is hemodynamically “ready” for anesthesia; intermediate values indicate areas needing optimization; high scores imply risk and the need for further workup.
References:
Fellahi JL, et al. Ann Intensive Care 2021.
AHA/ACC 2024 Perioperative Cardiovascular Evaluation Guidelines.
Canadian Cardiovascular Society Guidelines on perioperative BNP/NT-proBNP.
Monk TG, et al. Anesthesiology 2019.
Michard F. Anesthesiology 2005; PPV/SVV thresholds in mechanical ventilation.
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