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Dana E, Dana HK, De Castro C, Bueno Rey L, Li Q, Tomlinson G, Khan JS. Inferior vena cava ultrasound to predict hypotension after general anesthesia induction: a systematic review and meta-analysis of observational studies. Can J Anaesth 2024; 71:1078-1091. [PMID: 38961000 DOI: 10.1007/s12630-024-02776-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 07/05/2024] Open
Abstract
PURPOSE Hypotension after induction of general anesthesia is common and is associated with significant adverse events. Identification of patients at high risk can inform the use of preoperative mitigation strategies. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the inferior vena cava collapsibility index (IVC-CI) and maximal diameter (dIVCmax) in predicting postinduction hypotension and to identify their predictive performance across different threshold ranges. METHODS We searched MEDLINE, PubMed®, and Embase from inception to March 2023 for prospective observational studies exploring the performance of IVC-CI and dIVCmax in predicting postinduction hypotension in adults presenting for elective surgery under general anesthesia. We excluded studies reporting on IVC parameters predicting postinduction hypotension in the obstetric patient population or exclusively in patients with obesity. Trials screening and data extraction were conducted independently. We performed meta-analyses to identify the performance of IVC parameters in predicting postinduction hypotension, followed by subgroup analyses that sought the IVC-CI range with the highest hierarchical summary receiver-operating characteristic area under the curve (HSROC-AUC). We used a bivariate random effects model to calculate summary estimates. We evaluated study quality using Newcastle-Ottawa scores and certainty of evidence using the GRADE framework. RESULTS We included 14 studies involving 1,166 patients. Pooled sensitivity and specificity of the IVC-CI to predict postinduction hypotension was 0.68 (95% confidence interval [CI], 0.55 to 0.79; coverage probability, 0.91) and 0.78 (95% CI, 0.69 to 0.85; coverage probability, 0.9), respectively, with an HSROC-AUC of 0.80 (95% CI, 0.68 to 0.85, high quality of evidence). An IVC-CI threshold range of 40-45% had an HSROC-AUC of 0.86 (95% CI, 0.69 to 0.93, high quality of evidence). CONCLUSIONS Preoperative IVC-CI is a strong predictor of postinduction hypotension. We recommend that future studies use an IVC-CI threshold of 40-45% (low certainty of evidence). Future studies are needed to establish whether ultrasound-guided preoperative optimization improves outcomes in high-risk patients. STUDY REGISTRATION PROSPERO ( CRD42022316140 ); first submitted 10 March 2022.
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Affiliation(s)
- Elad Dana
- Department of Anesthesia, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Mount Sinai Hospital, Toronto, ON, Canada.
| | - Hadas K Dana
- Division of Emergency Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Pediatric Emergency Department, Meir Medical Center, Kfar-Saba, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Charmaine De Castro
- Sidney Liswood Health Sciences Library, Sinai Health System, Toronto, ON, Canada
| | - Luz Bueno Rey
- Mount Sinai Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Qixuan Li
- Biostatistics Department, University Health Network, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Biostatistics Department, University Health Network, University of Toronto, Toronto, ON, Canada
| | - James S Khan
- Mount Sinai Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
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Milam AJ, Bonner T, Burton BN, Williams B, Youssef MR, Smith RN, Cannesson M, Troianos C, Pittet JF. The Difficulty Implementing Evidence-Based Practice in the Perioperative Setting. Anesth Analg 2024:00000539-990000000-00876. [PMID: 39052524 DOI: 10.1213/ane.0000000000006916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Adam J Milam
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Timethia Bonner
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Brittney Williams
- Department of Anesthesiology, University of Maryland, Baltimore, Baltimore, Maryland
| | - Mohanad R Youssef
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | | | - Jean-Francois Pittet
- Deparment of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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3
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Dai S, Chen L, Wu M, Guo L, Wang R. Timing of early water intake post-general anaesthesia: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:135. [PMID: 38594662 PMCID: PMC11003094 DOI: 10.1186/s12871-024-02520-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Early water intake has gained widespread attention considering enhanced recovery after surgery (ERAS). In the present systematic evaluation and meta-analysis, we assessed the effects of early water intake on the incidence of vomiting and aspiration in adult patients who received general anaesthesia on regaining consciousness during the resuscitation period. OBJECTIVE To systematically analyse the results of randomised controlled trials on early postoperative water intake in patients who underwent different types of surgery under general anaesthesia, both at home and abroad, to further explore the safety and application of early water intake and provide an evidence-based foundation for clinical application. DESIGN Systematic review and meta-analysis. METHODS To perform the systematic evaluation and meta-analysis, we searched the Web of Science, CINAHL, Embase, PubMed, Cochrane Library, Sinomed, China National Knowledge Infrastructure (CNKI), Wanfang, and Vipshop databases to identify randomised controlled trial studies on early water intake in adult patients who received general anaesthesia. RESULTS Herein, we included 10 publications with a total sample size of 5131 patients. Based on statistical analysis, there was no statistically significant difference in the incidence of vomiting (odds ratio [OR] = 0.81; 95% confidence interval [CI] [0.58-1.12]; p = 0.20; I-squared [I2] = 0%) and aspiration (OR = 0.78; 95%CI [0.45-1.37]; p = 0.40; I2 = 0%) between the two groups of patients on regaining consciousness post-general anaesthesia. CONCLUSION Based on the available evidence, early water intake after regaining consciousness post-anaesthesia did not increase the incidence of adverse complications when compared with traditional postoperative water abstinence. Early water intake could effectively improve patient thirst and facilitate the recovery of gastrointestinal function.
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Affiliation(s)
- Suwan Dai
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Lingyan Chen
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Min Wu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Liangyou Guo
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Rong Wang
- The First Hospital of Jiaxing, Jiaxing, China.
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4
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Sims CR, Abou Chaar MK, Kerfeld MH, Cassivi SD, Hofer RE, Nichols FC, Reisenauer J, Saddoughi SS, Shen KR, Stewart TM, Tapias LF, Wigle DA, Blackmon SH. Esophagectomy Enhanced Recovery After Surgery Initiative Results in Improved Outcomes. Ann Thorac Surg 2024; 117:847-857. [PMID: 38043851 DOI: 10.1016/j.athoracsur.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/19/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Esophagectomy for esophageal cancer is a procedure with high morbidity and mortality. This study developed a Multidisciplinary Esophagectomy Enhanced Recovery Initiative (MERIT) pathway and analyzed implementation outcomes in a single institution. METHODS The MERIT pathway was developed as a practice optimization and quality improvement initiative. Patients were studied from November 1, 2021 to June 20, 2022 and were compared with historical control subjects. The Wilcoxon rank sum test and the Fisher exact test were used for statistical analysis. RESULTS The study compared 238 historical patients (January 17, 2017 to December 30, 2020) with 58 consecutive MERIT patients. There were no significant differences between patient characteristics in the 2 groups. In the MERIT group, 49 (85%) of the patients were male, and their mean age was 65 years (range, 59-71 years). Most cases were performed for esophageal cancer after neoadjuvant therapy. Length of stay improved by 27% from 11 to 8 days (P = .27). There was a 12% (P = .05) atrial arrhythmia rate reduction, as well as a 9% (P = .01) decrease in postoperative ileus. Overall complications were reduced from 54% to 35% (-19%; P = .01). CONCLUSIONS This study successfully developed and implemented an enhanced recovery after surgery pathway for esophagectomy. In the first year, study investigators were able to reduce overall complications, specifically atrial arrhythmias, and postoperative ileus.
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Affiliation(s)
- Charles R Sims
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamad K Abou Chaar
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mitchell H Kerfeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen D Cassivi
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ryan E Hofer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Francis C Nichols
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Janani Reisenauer
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sahar S Saddoughi
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - K Robert Shen
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Thomas M Stewart
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Luis F Tapias
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dennis A Wigle
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Shanda H Blackmon
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Canac J, Faucher M, Depeyre F, Tourret M, Tezier M, Cambon S, Ettori F, Servan L, Alisauskaite J, Pouliquen C, Gonzalez F, Bisbal M, Sannini A, de Guibert JM, Lambaudie E, Turrini O, Chow-Chine L, Mokart D. Factors Associated with 1-Year Mortality in Elderly Patients (Age ≥ 80 Years) with Cancer Undergoing Major Abdominal Surgery: A Retrospective Cohort Study. Ann Surg Oncol 2023; 30:8083-8093. [PMID: 37814178 DOI: 10.1245/s10434-023-14365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND The number of elderly patients undergoing major abdominal surgery is increasing, but the factors affecting their postoperative outcomes remain unclear. This study aimed to identify the factors associated with 1-year mortality among elderly patients (age ≥ 80 years) with cancer undergoing major abdominal surgery. METHODS This retrospective cohort study was conducted from March 2009 to December 2020. The study enrolled 378 patients 80 years old or older who underwent major abdominal surgery. The main outcome was 1-year mortality, and the factors associated with mortality were analyzed. RESULTS Of the 378 patients, 92 died at 1 year (24.3%), whereas the 30-day mortality rate was 4% (n = 15). In the multivariate analysis, the factors independently associated with 1-year mortality were preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS) score higher than 1 (odds ratio [OR], 3.189; 95% confidence interval [CI], 1.595-6.377; p = 0.001), preoperative weight loss greater than 3 kg (OR, 2.145; 95% CI, 1.044-4.404; p = 0.038), use of an intraoperative vasopressor (OR, 3.090; 95% CI, 1.188-8.042; p = 0.021), and postoperative red blood cell units (OR, 1.212; 95% CI, 1.045-1.405; p = 0.011). Survival was associated with perioperative management according to an enhanced recovery after surgery (ERAS) protocol (OR, 0.370; 95% CI, 0.160-0.854; p = 0.006) and supramesocolic surgery (OR, 0.371; 95% CI, 0.158-0.871; p = 0.023). CONCLUSION The study identified several factors associated with an encouraging 1-year mortality rate in this setting. These results highlight the need for identification of suitable targets to optimize pre-, intra-, and postoperative management in order to improve outcomes for this vulnerable population.
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Affiliation(s)
- Julie Canac
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Marion Faucher
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Fanny Depeyre
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Maxime Tourret
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Marie Tezier
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Sylvie Cambon
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Florence Ettori
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Luca Servan
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Jurgita Alisauskaite
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Camille Pouliquen
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Frédéric Gonzalez
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Magali Bisbal
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Antoine Sannini
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | | | - Eric Lambaudie
- Département de Chirurgie, Institut Paoli Calmette, Marseille, France
| | - Olivier Turrini
- Département de Chirurgie, Institut Paoli Calmette, Marseille, France
| | - Laurent Chow-Chine
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Djamel Mokart
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
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Berger Y, Sullivan BJ, Bekhor EY, Carpiniello M, Leigh NL, Pletcher ER, Solomon D, Sarpel U, Hiotis SP, Labow DM, Cohen NA, Golas BJ. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Effects of postoperative fluids beyond the first 24 h. J Surg Oncol 2023; 128:1133-1140. [PMID: 37519102 DOI: 10.1002/jso.27407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND OBJECTIVES There are no guidelines for intravenous fluid (IVF) administration after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). This study assessed rates of post-CRS/HIPEC morbidity according to perioperative IVF administration. METHODS All patients undergoing CRS/HIPEC March 2007 to June 2018 were reviewed, recording clinicopathologic, operative, and postoperative variables. Patients were divided by peritoneal cancer index (PCI), comparing IVF volumes and types administered intraoperatively and during the first 72 h postoperatively. Optimal IVF rate cutoffs calculated using area under the receiver operating characteristic curves and Youden's index determined associations with complications. RESULTS Overall, 185 patients underwent CRS/HIPEC, and 81 (51%) had low PCI (<10) and 77 (49%) had high PCI (≥10). In low-PCI patients, high IVF rates on postoperative days (POD) #0-2 were associated with higher overall complications: POD#0 (46% vs. 89%, p = 0.001), POD#1 (40% vs. 86%, p < 0.05), and POD#2 (42% vs. 72%, p < 0.05). High IVF rates were associated with respiratory distress (7% vs. 26%, p = 0.02) on POD#0, ileus (14% vs. 47%, p = 0.007) and intensive care unit stay (11% vs. 33%, p = 0.022) on POD#1, and ICU stay (8% vs. 33%, p = 0.003) on POD#2. CONCLUSIONS For low PCI patients undergoing CRS/HIPEC, higher IVF rates were associated with postoperative complications. Post-CRS/HIPEC, IVF rates should be limited to prevent morbidity.
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Affiliation(s)
- Yael Berger
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brianne J Sullivan
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eliahu Y Bekhor
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew Carpiniello
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Natasha L Leigh
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric R Pletcher
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Solomon
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Umut Sarpel
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Spiros P Hiotis
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel M Labow
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Noah A Cohen
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin J Golas
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zhang JG, Li HW, Wu XM, Yu HB, Liu YH, Qi L, Bai Y, Yang L, Zhang HL, Wang XY, Jia YQ. The impact of enhanced recovery after surgery on inflammatory indicators and prognosis related to complex appendicitis in children. Front Pediatr 2023; 11:1261191. [PMID: 37928355 PMCID: PMC10623122 DOI: 10.3389/fped.2023.1261191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Objective To explore the application effect of enhanced recovery after surgery (ERAS) perioperative plan in the treatment of complex appendicitis in children, and further enrich the implementation plan of ERAS in the field of pediatric surgery. Method This study selected 122 children who underwent laparoscopic complex appendectomy at Inner Mongolia Maternal and Child Health Hospital and Baotou Fourth Hospital from August 2018 to July 2022, and randomly divided them into a traditional surgery group (TS) and an enhanced recovery surgery group (ERAS). The changes of white blood cell (WBC), hypersensitive C-reactive protein (CRP), pro Calcitonin (PCT) and interleukin 6 (IL-6) before and after surgery were compared. The degree of pain, recovery time of intestinal function, length of hospital stay, hospital costs, postoperative complications and parental satisfaction were compared between the two groups. Result The WBC and CRP levels in the ERAS group at 6 h after surgery, as well as the IL-6 levels on the 3rd day after surgery, were lower than those in the TS group. Meanwhile, the analgesic effect of ERAS group at 3 h and 6 h after surgery was better than that of TS group. And the ERAS group had a shorter postoperative first exhaust time, fewer overall hospital stays, and lower hospitalization costs. In addition, the ERAS group had high parental satisfaction during hospitalization. There was no statistically significant difference in postoperative complications between the two groups of children. Conclusion ERAS can promote postoperative recovery of children, reduce surgical stress, save family medical expenses, alleviate the pain of children, and improve parental satisfaction. It is a safe and effective method for treating complex appendicitis in children.
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Affiliation(s)
- Jian-Guo Zhang
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Hao-Wei Li
- Pediatric Surgery, The Fourth Hospital of Baotou, Baotou, China
| | - Xiang-Ming Wu
- Pediatric Surgery, The Fourth Hospital of Baotou, Baotou, China
| | - Hai-Bin Yu
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Yan-Hui Liu
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Lin Qi
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Yu Bai
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Lin Yang
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Hai-Long Zhang
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Xiao-Yun Wang
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Yue-Qi Jia
- Pediatric Surgery, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
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Malbrain MLNG, Caironi P, Hahn RG, Llau JV, McDougall M, Patrão L, Ridley E, Timmins A. Multidisciplinary expert panel report on fluid stewardship: perspectives and practice. Ann Intensive Care 2023; 13:89. [PMID: 37747558 PMCID: PMC10519908 DOI: 10.1186/s13613-023-01177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Although effective and appropriate fluid management is a critical aspect of quality care during hospitalization, the widespread adoption of consistent policies that ensure adequate fluid stewardship has been slow and heterogenous. Despite evidence-based guidelines on fluid management being available, clinical opinions continue to diverge on important aspects of care in this setting, and the consistency of guideline implementation is far from ideal. A multidisciplinary panel of leading practitioners and experts convened to discuss best practices for ongoing staff education, intravenous fluid therapy, new training technologies, and strategies to track the success of institutional fluid stewardship efforts. Fluid leads should be identified in every hospital to ensure consistency in fluid administration and monitoring. In this article, strategies to communicate the importance of effective fluid stewardship for the purposes of education, training, institutional support, and improvement of patient outcomes are reviewed and recommendations are summarized.
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Affiliation(s)
- Manu L N G Malbrain
- First Department Anaesthesiology and Intensive Therapy, Medical University Lublin, Lublin, Poland.
- International Fluid Academy, Lovenjoel, Belgium.
- Medical Data Management, Medaman, Geel, Belgium.
- Medical Management, AZ Oudenaarde Hospital, Oudenaarde, Belgium.
| | - Pietro Caironi
- Department of Anesthesia and Critical Care, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
- Department of Oncology, University of Turin, Turin, Italy
| | - Robert G Hahn
- Anesthesia and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Juan V Llau
- Anaesthesiology and Post-Surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain
- Anaesthesiology, Department of Surgery, University of Valencia, Valencia, Spain
| | - Marcia McDougall
- Anaesthetics and Intensive Care, Victoria Hospital, Kirkcaldy, Fife, Scotland
| | - Luís Patrão
- Intensive Care Unit, Centro HospitalarTondela-Viseu, EPE, Viseu, Portugal
- UpHill Health, Lisbon, Portugal
| | - Emily Ridley
- Fluid Management lead, Department of Nursing, Victoria Hospital, Kirkcaldy, Fife, Scotland
| | - Alan Timmins
- Pharmacy Department, Victoria Hospital, Kirkcaldy, Fife, Scotland
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Zhang Y, Zhan L, Li D, Huang G, Lan Y. Influence of goal-directed fluid therapy guided by the Vigileo-FloTrac TM system on intestinal mucosal barrier function in elderly patients with colorectal cancer. Wideochir Inne Tech Maloinwazyjne 2023; 18:460-466. [PMID: 37868288 PMCID: PMC10585464 DOI: 10.5114/wiitm.2023.128010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/12/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Colorectal cancer is a clinically common malignancy arising in the digestive tract. Aim To evaluate the influence of goal-directed fluid therapy (GDFT) guided by the Vigileo-FloTracTM system on intestinal mucosal barrier function in elderly patients with colorectal cancer. Material and methods A prospective study was conducted on 106 elderly patients with colorectal cancer. They were divided into control and research groups (n = 53) using a random number table, and subjected to conventional fluid therapy and Vigileo-FloTracTM system-guided GDFT, respectively. Their intraoperative indicators, postoperative indicators, and changes of haemodynamics, oxygen metabolism, intestinal mucosal barrier function at different time points, and incidence rates of complications were compared. Results Compared with the control group, the intraoperative urine volume, colloid fluid volume, crystalloid fluid volume, and total infusion volume were lower, and the first postoperative exhaust time, first postoperative feeding time, and hospital stay were shorter in the research group (p < 0.05). At T1 and T2, mean artery pressure, heart rate, central venous pressure, oxygen consumption, oxygen delivery, and oxygen extraction ratio in the research group were lower than in the control group, but all of them first rose and then fell in the 2 groups (p < 0.05). On the 3rd day after surgery, the levels of serum endothelin, diamine oxidase and D-lactate declined in both groups, and the decline was more obvious in the research group (p < 0.05). Conclusions GDFT guided by the Vigileo-FloTracTM system is beneficial to the prognosis of patients by effectively decreasing fluid infusion.
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Affiliation(s)
- Yunfeng Zhang
- Department of Anaesthesiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Linsen Zhan
- Department of Anaesthesiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Dong Li
- Department of Anaesthesiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Gang Huang
- Department of Anaesthesiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Yunping Lan
- Department of Anaesthesiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
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Ma H, Li X, Wang Z, Qiao Q, Gao Y, Yuan H, Guan B, Guan Z. The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study. Perioper Med (Lond) 2023; 12:33. [PMID: 37430359 DOI: 10.1186/s13741-023-00327-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. METHODS Patients, more than 60 years old, undergoing thoracoscopic pulmonary resection for non-small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI), and mean arterial pressure (MAP) and maintained the SVV < 13%, CI > 2.5 L/min/m2, and MAP > 65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP > 65 mmHg. The incidence of postoperative acute kidney injury (AKI) and pulmonary and cardiac complications was compared. RESULTS Two-hundred seventy-six patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were more; the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P = 0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9 ± 25.2 μmol/L vs 97.1 ± 17.6 μmol/L; P = 0.048). CONCLUSIONS Under ERAS program, there was no significant difference of AKI incidence between GDFT and RFT in elderly patients undergoing thoracoscopic pulmonary resection. But postoperative increase degree of serum creatinine was lower in GDFT group. TRIAL REGISTRATION Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.
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Affiliation(s)
- Hongmei Ma
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Anesthesiology, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Xin Li
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhe Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiao Qiao
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yanfeng Gao
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hui Yuan
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bin Guan
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zheng Guan
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Brown JK, Shaw AD, Mythen MG, Guzzi L, Reddy VS, Crisafi C, Engelman DT. Adult Cardiac Surgery-Associated Acute Kidney Injury: Joint Consensus Report. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00340-3. [PMID: 37355415 DOI: 10.1053/j.jvca.2023.05.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES Acute kidney injury (AKI) is increasingly recognized as a source of poor patient outcomes after cardiac surgery. The purpose of the present report is to provide perioperative teams with expert recommendations specific to cardiac surgery-associated AKI (CSA-AKI). METHODS This report and consensus recommendations were developed during a joint, in-person, multidisciplinary conference with the Perioperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society. Multinational practitioners with diverse expertise in all aspects of cardiac surgical perioperative care, including clinical backgrounds in anesthesiology, surgery and nursing, met from October 20 to 22, 2021, in Sacramento, California, and used a modified Delphi process and a comprehensive review of evidence to formulate recommendations. The quality of evidence and strength of each recommendation were established using the Grading of Recommendations Assessment, Development, and Evaluation methodology. A majority vote endorsed recommendations. RESULTS Based on available evidence and group consensus, a total of 13 recommendations were formulated (4 for the preoperative phase, 4 for the intraoperative phase, and 5 for the postoperative phase), and are reported here. CONCLUSIONS Because there are no reliable or effective treatment options for CSA-AKI, evidence-based practices that highlight prevention and early detection are paramount. Cardiac surgery-associated AKI incidence may be mitigated and postsurgical outcomes improved by focusing additional attention on presurgical kidney health status; implementing a specific cardiopulmonary bypass bundle; using strategies to maintain intravascular euvolemia; leveraging advanced tools such as the electronic medical record, point-of-care ultrasound, and biomarker testing; and using patient-specific, goal-directed therapy to prioritize oxygen delivery and end-organ perfusion over static physiologic metrics.
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Affiliation(s)
- Jessica K Brown
- Department of Anesthesiology and Perioperative Medicine, the University of Texas, MD Anderson Cancer Center, Houston, TX.
| | - Andrew D Shaw
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio
| | - Monty G Mythen
- University College London National Institute of Health Research Biomedical Research Center, London, United Kingdom
| | - Lou Guzzi
- Department of Critical Care Medicine, AdventHealth Medical Group, Orlando, Florida
| | | | - Cheryl Crisafi
- Heart & Vascular Program, Baystate Health, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Daniel T Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Medical School-Baystate, Springfield, MA
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12
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Conti D, Pandolfini L, Ballo P, Falsetto A, Zini C, Goti M, Cappelli V, Pissilli G, Laessig R, Scatizzi M, Pavoni V. The Role of the Recovery Room in Improving Adherence During an Enhanced Recovery After Surgery (ERAS) Implementation Program for Colorectal Surgery: A Single-Center Retrospective Analysis. J Perianesth Nurs 2023; 38:232-235. [PMID: 36241540 DOI: 10.1016/j.jopan.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/25/2022] [Accepted: 04/30/2022] [Indexed: 03/27/2023]
Abstract
PURPOSE The purpose of thisstudy was to evaluate the clinical impact of the Recovery Room (RR) in an Enhanced Recovery After Surgery (ERAS) pathway in colorectal surgery. DESIGN Single-center retrospective study. METHODS From November 2019 until September 2021, a total of 149 consecutive patients that underwent to colon-rectal surgery were enrolled. The patients were divided into two study groups: RR Group if admitted to RR after surgery, and no-Recovery Room (NRR) Group if monitored directly on the ward, bypassing the RR. The postoperative ERAS items adherence was assessed in the two study groups. FINDINGS Final analysis included 119 patients in the RR Group and 30 patients in NRR Group. Patients that started clear liquid oral intake within two hours postoperatively were 118 in the RR group and 19 in the NRR group (99.1% vs 63.3%, P < .001). A total of 98 patients and 18 patients were mobilized on day 0 in the RR group and in NRR group, respectively (84.4% vs 15.5%, P < .05). In the RR group, postoperative adherence to the ERAS protocol components was higher in comparison with the NRR group (P < .003); adherence to the all protocol components was also higher (P < .004). CONCLUSIONS Among patients undergoing colorectal surgery admitted to RR after surgery, the RR nurse guaranteed effective patient assistance and ensured appropriate compliance to the postoperative ERAS items.
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Affiliation(s)
- Duccio Conti
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.
| | - Lorenzo Pandolfini
- General Surgery Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Alessandro Falsetto
- General Surgery Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Chiara Zini
- Department of Radiology, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marta Goti
- Department of Clinical Nursing, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Valentina Cappelli
- Department of Clinical Nursing, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Gaia Pissilli
- Department of Clinical Nursing, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Romana Laessig
- General Surgery Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Vittorio Pavoni
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
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13
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Sato H, Ota H, Munakata K, Matsuura Y, Fujii M, Wada N, Takiuchi D, Hama N, Takachi K, Yukawa M. Perioperative fluid management influences complication rates and length of hospital stay in the enhanced recovery after surgery (ERAS) protocol for patients with colorectal cancer. Surg Today 2023; 53:242-251. [PMID: 35933631 DOI: 10.1007/s00595-022-02568-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/18/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol and quantify the impact of each ERAS item on postoperative outcomes. METHODS We used a generalized linear model to compare 289 colorectal cancer patients treated with the ERAS protocol between June, 2015 and April, 2021, with 99 colorectal cancer patients treated with the conventional colorectal surgery pathway between April, 2014 and June, 2015. RESULTS The median length of hospital stay (LOHS) was significantly shorter in the ERAS group, at 9 days (range 3-104 days) vs. 14 days (range 4-44 days) (p < 0.001), but the complication rates (Clavien-Dindo grade 2 or more) were similar (16.6% vs. 22.2%; p = 0.227). However, in the ERAS group, the higher the compliance with ERAS items, the lower the complication rate and LOHS (both p < 0.001). Multiple regression analysis demonstrated that "Discontinuation of continuous intravenous infusion on POD1" and "Avoidance of fluid overload" were significantly associated with the LOHS (p < 0.001 and p = 0.008). CONCLUSION The ERAS protocol is safe and effective for elective colorectal cancer surgery, and compliance with the ERAS protocol contributes to shorter LOHS and fewer complications. Items related to perioperative fluid management had a crucial impact on these outcomes.
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Affiliation(s)
- Hiromichi Sato
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Hirofumi Ota
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan.
| | - Koji Munakata
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Yusuke Matsuura
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Makoto Fujii
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Noriko Wada
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Daisuke Takiuchi
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Naoki Hama
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Kou Takachi
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Masao Yukawa
- Department of General and Breast Surgery, Ikeda City Hospital, Ikeda, Japan
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Kaiser JM, Helm MC, Higgins RM, Kastenmeier AS, Rein LE, Goldblatt MI. Auto-diuresis Predicts Return of Bowel Function. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:528-533. [PMID: 35960701 DOI: 10.1097/sle.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Feeding a ventral hernia repair (VHR) patient before the return of bowel function (ROBF) can lead to distention and emesis. Many patients spontaneously diurese after surgery. We hypothesized that this auto-diuresis would signal ROBF. MATERIALS AND METHODS A total of 395 patients who underwent open, laparoscopic, or mixed VHR were evaluated for correlation between fluid status and ROBF or discharge. ROBF within 24 hours and discharge within 24 hours or 48 hours were used as outcome measures. RESULTS Patients remained an average 3.59 days after surgery in the hospital and the average ROBF was on day 2.99. The first shift of ≥700 mL of urine predicted ROBF (P=0.03) and discharge (P=0.04) within 24 hours. The first shift output of ≥500 mL predicted discharge within 48 hours (P=0.02). CONCLUSION Auto-diuresis after surgery is correlated to ROBF and discharge. Accurate fluid measurement can predict bowel function and allow early diet and discharge.
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Affiliation(s)
| | | | | | | | - Lisa E Rein
- Department of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
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15
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Aydın Sayılan A, Yıldızeli Topçu S. Do the Fluids Consumed by Surgical Patients in the Postoperative Period Affect Their Gastrointestinal Motility?: A Correlational Study. J Perianesth Nurs 2022; 37:907-912. [PMID: 35835635 DOI: 10.1016/j.jopan.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to determine the relationship between gastrointestinal (GI) motility and oral fluid intake levels in the postoperative period. DESIGN This descriptive and correlational study was performed in an education and research hospital between June and September 2019. METHODS The sample in this study consisted of individuals aged 18 to 80 years who had undergone laparoscopic abdominal surgery. No sampling was performed, and all patients volunteering to take part were included. FINDINGS Patients were started on oral nutrition in a median of 6 hours (min: 6 max: 8) after surgery and received 500.00 mL (min: 100 max: 500) oral fluid on the first day after surgery, 600.00 mL (min: 200 max: 1200) on the second, and 725.00 mL (min: 652.47 max: 759.52) on the third. Median time to passage of flatus was 22.50 hours (min: 6 max: 36), and median time to stool production was 39.00 hours (min: 16 max: 70). A positive correlation was found between the amount of oral fluid consumption on the first day and time to passage of flatus, while a negative correlation was observed between the amount of fluid consumption on the second day and time to both flatus and stool production. CONCLUSIONS Time to flatus production increased in line with the amount of fluid consumed via the oral route on the first day postoperatively, while times to production of flatus and stool decreased as the amount of fluid consumed orally on the second day increased.
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Affiliation(s)
- Aylin Aydın Sayılan
- Kirklareli University, Faculty of Health Science, Nursing Department, Kirklareli, Turkey.
| | - Scide Yıldızeli Topçu
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey
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16
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Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic. HEALTHCARE (BASEL, SWITZERLAND) 2021; 9:healthcare9050549. [PMID: 34066696 PMCID: PMC8150975 DOI: 10.3390/healthcare9050549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
This work aims to describe the implementation and subsequent learnings from the first decade after the full implementation of enhanced recovery pathway for colorectal surgery at a single institution. This paper will describe the diffusion efforts and plans through the Define, Measure, Analyze, Improve, Control (DMAIC) process of ongoing quality improvement and through research efforts. The information applies to all readers that provide surgical care within their organization as the fundamental principles of enhanced recovery for surgery are applicable regardless of the setting.
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Perioperative nursing principles guided by the concept of enhanced recovery after surgery†. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.
Methods
Pubmed, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Database, and VIP Database were searched to obtain the relevant literature involving enhanced recovery after surgery (ERAS) guidance, obtain the effective clinical data, review the reports in literature, and obtain the effective scheme.
Results
Compared with the traditional nursing program, perioperative nursing principles guided by the concept of ERAS provide more accurate nursing care to patients and reduce the occurrence of intraoperative stress events through comprehensive nursing measures such as preoperative pre-rehabilitation measures, intraoperative body temperature and fluid management, postoperative analgesia, prevention of nausea and vomiting, early mobilization, catheter nursing, and better out-of-hospital follow-up.
Conclusions
Perioperative nursing principles guided by the concept of ERAS can significantly reduce the incidence of perioperative complications, shorten the hospital stay of patients, and promote postoperative rehabilitation of patients. The transformation and implementation of this concept can bring significant benefits to hospitals, medical care, and patients.
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Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery. J Clin Med 2021; 10:jcm10081634. [PMID: 33921433 PMCID: PMC8069722 DOI: 10.3390/jcm10081634] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) aims to improve patient outcomes by controlling specific aspects of perioperative care. The concept was introduced in 1997 by Henrik Kehlet, who suggested that while minor changes in perioperative practise have no significant impact alone, incorporating multiple changes could drastically improve outcomes. Since 1997, significant advancements have been made through the foundation of the ERAS Society, responsible for creating consensus guidelines on the implementation of enhanced recovery pathways. ERAS reduces length of stay by an average of 2.35 days and healthcare costs by $639.06 per patient, as identified in a 2020 meta-analysis of ERAS across multiple surgical subspecialties. Carbohydrate loading, bowel preparation and patient education in the pre-operative phase, goal-directed fluid therapy in the intra-operative phase, and early mobilisation and enteral nutrition in the post-operative phase are some of the interventions that are commonly implemented in ERAS protocols. While many specialties have been quick to incorporate ERAS, uptake has been slow in the transplantation field, leading to a scarcity of literature. Recent studies reported a 47% reduction in length of hospital stay (LOS) in liver transplantation patients treated with ERAS, while progress in kidney transplantation focuses on pain management and its incorporation into enhanced recovery protocols.
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D'Souza RS, Sims CR, Andrijasevic N, Stewart TM, Curry TB, Hannon JA, Blackmon S, Cassivi SD, Shen RK, Reisenauer J, Wigle D, Brown MJ. Pulmonary Complications in Esophagectomy Based on Intraoperative Fluid Rate: A Single-Center Study. J Cardiothorac Vasc Anesth 2021; 35:2952-2960. [PMID: 33546968 DOI: 10.1053/j.jvca.2021.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Esophagectomy is associated with significant morbidity and mortality. The authors assessed the relationship between intraoperative fluid (IOF) administration and postoperative pulmonary outcomes in patients undergoing a transthoracic, transhiatal, or tri-incisional esophagectomy. DESIGN Retrospective cohort study (level 3 evidence). SETTING Tertiary care referral center. PARTICIPANTS Patients who underwent esophagectomy from 2007 to 2017. INTERVENTIONS The IOF rate (mL/kg/h) was the predictor variable analyzed both as a continuous and binary categorical variable based on median IOF rate for this cohort (11.90 mL/kg/h). MEASUREMENTS Primary outcomes included rates of acute respiratory distress syndrome (ARDS) within ten days after esophagectomy. Secondary outcomes included rates of reintubation, pneumonia, cardiac or renal morbidity, intensive care unit admission, length of stay, procedure-related complications, and mortality. Multivariate regression analysis determined associations between IOF rate and postoperative outcomes. Analysis was adjusted for age, sex, body mass index, procedure type, year, and thoracic epidural use. MAIN RESULTS A total of 1,040 patients comprised this cohort. Tri-incisional esophagectomy was associated with a higher hospital mortality rate (7.8%) compared with transthoracic esophagectomy (2.6%, p = 0.03) or transhiatal esophagectomy (0.7%, p = 0.01). Regression analysis revealed a higher IOF rate was associated with greater ARDS within ten days (adjusted odds ratio [OR] = 1.03, p = 0.01). For secondary outcomes, a higher IOF rate was associated with greater hospital mortality (adjusted OR = 1.05, p = 0.002), although no significant association with 30-day hospital mortality was identified. CONCLUSIONS Increased IOF administration during esophagectomy may be associated with worse postoperative pulmonary complications, specifically ARDS. Future well-powered studies are warranted, including randomized, controlled trials comparing liberal versus restrictive fluid administration in this surgical population.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Charles R Sims
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Division of Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Nicole Andrijasevic
- Department of Respiratory Therapy, Mayo Clinic, Rochester, MN; Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, MN
| | - Thomas M Stewart
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Timothy B Curry
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - James A Hannon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Robert K Shen
- Department of Thoracic Surgery, Mayo Clinic, Rochester, MN
| | | | - Dennis Wigle
- Department of Thoracic Surgery, Mayo Clinic, Rochester, MN
| | - Michael J Brown
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Sim J, Kwak JY, Jung YT. Association between postoperative fluid balance and mortality and morbidity in critically ill patients with complicated intra-abdominal infections: a retrospective study. Acute Crit Care 2020; 35:189-196. [PMID: 32811137 PMCID: PMC7483013 DOI: 10.4266/acc.2020.00031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/05/2020] [Indexed: 12/29/2022] Open
Abstract
Background Postoperative fluid overload may increase the risk of developing pulmonary complications and other adverse outcomes. We evaluated the impact of excessive fluid administration on postoperative outcomes in critically ill patients. Methods We reviewed the medical records of 320 patients admitted to intensive care unit (ICU) after emergency abdominal surgery for complicated intra-abdominal infection (cIAI) between January 2013 and December 2018. The fluid balance data of the patients were reviewed for a maximum of 7 days. The patients were grouped based on average daily fluid balance with a cutoff value of 20 ml/kg/day. Propensity score matching was performed to reduce the underlying differences between the groups. Results Patients with an average daily fluid balance of ≥20 ml/kg/day were associated with higher rates of 30-day mortality (11.8% vs. 2.4%; P=0.036) than those with lower fluid balance (<20 ml/kg/day). Kaplan-Meier survival curves for 30-day mortality in these groups also showed a better survival rate in the lower fluid balance group with a statistical significance (P=0.020). The percentage of patients who developed pulmonary consolidation during ICU stay (47.1% vs. 24.7%; P=0.004) was higher in the fluid-overloaded group. Percentages of newly developed pleural effusion (61.2% vs. 57.7%; P=0.755), reintubation (18.8% vs. 10.6%; P=0.194), and infectious complications (55.3% vs. 49.4%; P=0.539) showed no significant differences between the two groups. Conclusions Postoperative fluid overload in patients who underwent emergency surgery for cIAI was associated with higher 30-day mortality and more frequent occurrence of pulmonary consolidation. Postoperative fluid balance should be adjusted carefully to avoid adverse clinical outcomes.
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Affiliation(s)
- Joohyun Sim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jae Young Kwak
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Yun Tae Jung
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Liu X, Wang Y, Fu Z. Impact of enhanced recovery after surgery on postoperative neutrophil-lymphocyte ratio in patients with colorectal cancer. J Int Med Res 2020; 48:300060520925941. [PMID: 32495673 PMCID: PMC7273621 DOI: 10.1177/0300060520925941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate the impact of enhanced recovery after surgery (ERAS) on the postoperative neutrophil-lymphocyte ratio (NLR) in patients with colorectal cancer. METHODS A total of 200 patients with colorectal cancer who underwent surgery between January 2015 and November 2018 were enrolled in the study. They were divided into a traditional treatment group (n=100) and an ERAS group (n=100). The traditional treatment group underwent radical laparoscopic colorectal surgery, and the ERAS group underwent traditional treatment plus the ERAS protocol (preoperative improvement of glucose tolerance, unconventional indwelling stomach and urinary tubes, intraoperative body temperature management, fluid management, postoperative pain management, early oral feeding, and early activities). Clinical data were collected for all patients. NLR levels before and after surgery, and complications were compared between the two groups. RESULTS Postoperative NLR was significantly lower in the ERAS compared with the traditional treatment group. The incidence of complications, including anastomotic leakage, pulmonary infection, urinary tract infection, and cardiopulmonary dysfunction were also significantly lower in the ERAS group. CONCLUSION Enhanced recovery after surgery can reduce the increase in postoperative NLR and reduce the occurrence of postoperative complications, which results will be of clinical value.
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Affiliation(s)
- Xiao Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of General Surgery, The Fifth People's Hospital of Chongqing, Chongqing, China
| | - Yuwei Wang
- Cancer Radiotherapy Center of Chongqing Cancer Hospital, Chongqing, China
| | - Zhongxue Fu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Smith BB, Mauermann WJ, Yalamuri SM, Frank RD, Gurrieri C, Arghami A, Smith MM. Intraoperative Fluid Balance and Perioperative Outcomes After Aortic Valve Surgery. Ann Thorac Surg 2020; 110:1286-1293. [PMID: 32151580 DOI: 10.1016/j.athoracsur.2020.01.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/09/2020] [Accepted: 01/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effect of intraoperative fluid balance on postoperative acute kidney injury (AKI) in cardiac surgical patients is poorly defined. METHODS In this retrospective study of patients undergoing aortic valve replacement for aortic stenosis, the primary outcome of interest was postoperative AKI. Secondary outcomes were postoperative fluid balance, cardiac index, vasopressor use, hospital-free days, stroke, myocardial infarction, hospital readmission, and 30- and 90-day mortality. RESULTS A total of 2327 patients were analyzed. Positive intraoperative fluid balance was associated with lower odds of AKI; the lowest odds were in the 20- to 39-mL/kg group (odds ratio, 0.56; 95% confidence interval, 0.38-0.81; P = .002). Positive intraoperative fluid balance was associated with a lower postoperative fluid balance. Increased ultrafiltration volume was associated with increased postoperative fluid resuscitation and vasopressor use. AKI was associated with increased 30- and 90-day mortality. Increased fluid balance was associated with increased odds of myocardial infarction and 30-day mortality. Increased ultrafiltration volume was associated with increased odds of 30- and 90-day mortality. CONCLUSIONS In patients who underwent aortic valve replacement for aortic stenosis, positive intraoperative fluid balance was associated with decreased odds of AKI. Patients developing AKI had increased 30- and 90-day mortality. Although the overall incidence was low, increased intraoperative fluid balance was associated with myocardial infarction and 30-day mortality, whereas increased ultrafiltration volume was associated with 30- and 90-day morality. Prospective studies are needed to better define proper intraoperative fluid management in patients undergoing cardiac surgery.
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Affiliation(s)
- Bradford B Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - William J Mauermann
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Suraj M Yalamuri
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Ryan D Frank
- Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Carmelina Gurrieri
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Arman Arghami
- Department of Surgery, Division of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
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Kay AH, Venn M, Urban R, Gray HJ, Goff B. Postoperative narcotic use in patients with ovarian cancer on an Enhanced Recovery After Surgery (ERAS) pathway. Gynecol Oncol 2019; 156:624-628. [PMID: 31882241 DOI: 10.1016/j.ygyno.2019.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the impact of an ERAS pathway on post-discharge narcotic use for patients with ovarian cancer undergoing open surgery. METHODS This was a retrospective cohort study of women who underwent open ovarian cancer surgeries in 2014 prior to ERAS ("pre-ERAS") and in 2016/2018 after ERAS was instituted ("ERAS"). Patients taking chronic narcotics were excluded. A statewide prescription monitoring program was used to identify narcotic prescriptions filled in the three months after surgery. Quantity of narcotic medication is referenced in morphine milligram equivalents (MME). RESULTS 42 pre-ERAS and 94 ERAS patients were included. The groups were similar in age, BMI, diabetes, tobacco use, mean number of prior abdominal/pelvic surgeries, and advanced stage disease. ERAS patients had a shorter hospital stay (6.7 days pre-ERAS vs 4.2 days ERAS, p = 0.003), used less narcotic in the 24 h prior to discharge (74.0 MME pre-ERAS vs 25.8 MME ERAS, p = 0.002), and filled prescriptions at time of discharge for less narcotic (519.9 MME pre-ERAS vs 339.7 MME ERAS, p = 0.011). After hospital discharge, ERAS patients filled fewer additional prescriptions (52.4% pre-ERAS, vs 29.4% ERAS, p = 0.012). In total, ERAS patients filled prescriptions for 55% fewer narcotics in the three months after surgery than the pre-ERAS group (1101.4 MME pre-ERAS vs 492.1 MME ERAS, p < 0.001). CONCLUSIONS Institution of an ERAS protocol appears to decrease the narcotic needs of patients in the three months after ovarian cancer surgery.
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Affiliation(s)
- Allison H Kay
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America.
| | - Monica Venn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America
| | - Renata Urban
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America
| | - Heidi J Gray
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America
| | - Barbara Goff
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America
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