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Lee S, Kim DY, Han J, Kim K, You AH, Kang HY, Park SW, Kim MK, Kim JE, Choi JH. Hemodynamic changes in the prone position according to fluid loading after anaesthesia induction in patients undergoing lumbar spine surgery: a randomized, assessor-blind, prospective study. Ann Med 2024; 56:2356645. [PMID: 38794845 PMCID: PMC11133492 DOI: 10.1080/07853890.2024.2356645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION A change from the supine to prone position causes hemodynamic alterations. We aimed to evaluate the effect of fluid preloading in the supine position, the subsequent hemodynamic changes in the prone position and postoperative outcomes. PATIENTS AND METHODS This prospective, assessor-blind, randomized controlled trial was conducted between March and June 2023. Adults scheduled for elective orthopaedic lumbar surgery under general anaesthesia were enrolled. In total, 80 participants were randomly assigned to fluid maintenance (M) or loading (L) groups. Both groups were administered intravenous fluid at a rate of 2 ml/kg/h until surgical incision; Group L was loaded with an additional 5 ml/kg intravenous fluid for 10 min after anaesthesia induction. The primary outcome was incidence of hypotension before surgical incision. Secondary outcomes included differences in the mean blood pressure (mBP), heart rate, pleth variability index (PVi), stroke volume variation (SVV), pulse pressure variation (PPV), stroke volume index and cardiac index before surgical incision between the two groups. Additionally, postoperative complications until postoperative day 2 and postoperative hospital length of stay were investigated. RESULTS Hypotension was prevalent in Group M before surgical incision and could be predicted by a baseline PVi >16. The mBP was significantly higher in Group L immediately after fluid loading. The PVi, SVV and PPV were lower in Group L after fluid loading, with continued differences at 2-3 time points for SVV and PPV. Other outcomes did not differ between the two groups. CONCLUSION Fluid loading after inducing general anaesthesia could reduce the occurrence of hypotension until surgical incision in patients scheduled for surgery in the prone position. Additionally, hypotension could be predicted in patients with a baseline PVi >16. Therefore, intravenous fluid loading is strongly recommended in patients with high baseline PVi to prevent hypotension after anaesthesia induction and in the prone position. TRIAL NUMBER KCT0008294 (date of registration: 16 March 2023).
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Affiliation(s)
- Sangho Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Doh Yoon Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jihoon Han
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Kyungmi Kim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ann Hee You
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sung Wook Park
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Mi Kyeong Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jung Eun Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
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Dumanlı Özcan AT, Taş N, Ersoy UC, Yamen K, Yılmaz Y, Özcan E, Ceylan C, Güleç H. Effects of intraoperative different fluid therapy protocols on postoperative renal functions. BMC Anesthesiol 2024; 24:299. [PMID: 39210300 PMCID: PMC11360291 DOI: 10.1186/s12871-024-02679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE Planning intraoperative fluid therapy in patients undergoing major abdominal surgery is important. It was aimed to define the difference between fluid therapy protocols for renal function, bleeding and postoperative service follow-ups. MATERIALS AND METHODS This is an observational case-controlled prospective study. Sixty patients aged 18-65 years who had undergone pancreatic surgery between December 2023- February 2023 were included in the study. Liberal (Group 1; n = 30) and targeted fluid therapies (Group 2; n = 30) were administered to the patients. Liberal fluid therapy was planned with 8-10 ml/kg/h crystalloid infusion. The targeted fluid therapy (TFT) group (Group 2; n = 30) began with a 2 ml/kg/h crystalloid infusion at the baseline. Additional fluid boluses were given in 250 ml of colloid infused over 10 min if PVI was > 13% for at least five minutes. The patients were staged using the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The amount of bleeding during surgery was recorded for both groups. RESULTS No significant difference was observed in postoperative renal function. A significant difference was observed in the amount of intraoperative bleeding. The amount of bleeding was greater in patients managed with liberal fluid therapy. No significant difference was observed between the groups in the oral intake (hour), drain withdrawal (hour) mobilization (hour) and discharge (day) times and there isn't any statistically significant differance between groups in cost effectivity (p>0.05). CONCLUSION Kidney function was preserved during individualized targeted fluid therapy using non-invasive haemodynamic monitoring parameters.
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Affiliation(s)
| | - Nisan Taş
- Department of Anaesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Umut Cahit Ersoy
- Department of Anaesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Kevser Yamen
- Department of Anaesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Yusuf Yılmaz
- Department of Anaesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Erdal Özcan
- Department of Anaesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Cengiz Ceylan
- General Surgery Department, İnönü University, Malatya, Turkey
| | - Handan Güleç
- Department of Anaesthesiology and Reanimation, Yıldırım Beyazıt University, Ankara, Turkey
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Lee S, Seo J, Kim DY, Lee Y, Kang HY, Choi JH, Kim Y, Kim MK, You AH. Comparison of Hemodynamic Parameters Based on the Administration of Remimazolam or Sevoflurane in Patients under General Anesthesia in the Beach Chair Position: A Single-Blinded Randomized Controlled Trial. J Clin Med 2024; 13:2364. [PMID: 38673637 PMCID: PMC11051199 DOI: 10.3390/jcm13082364] [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: 03/24/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: We aimed to evaluate whether the administration of remimazolam as a maintenance agent for general anesthesia affects the occurrence of hypotension compared with sevoflurane when switching to the beach chair position (BCP). Methods: We conducted a prospective randomized controlled trial from June 2023 to October 2023 in adult patients undergoing orthopedic surgery under general anesthesia in the BCP. A total of 78 participants were randomly allocated to the remimazolam (R) or sevoflurane (S) groups. The primary outcome was the incidence of hypotension that occurred immediately after switching to a BCP. The secondary outcomes included differences between the study groups in perioperative blood pressure (BP), heart rate (HR), endotracheal tube extubation time, postoperative complications, and hospital length of stay (LOS). Results: The incidence of hypotension immediately after switching to a BCP was significantly higher in the S group. The risk factors associated with hypotension included sevoflurane administration and a high baseline systolic BP. In the receiver operating characteristic curve analysis for the occurrence of hypotension after the transition to a BCP, the cutoff value for systolic BP was 142 mmHg. The perioperative BP and HR were higher in the R group at several timepoints. Postoperative endotracheal tube extubation time was shorter in the R group. There were no significant differences in the postoperative complications or hospital LOS between the two groups. Conclusions: Remimazolam should be considered as an anesthetic agent to prevent hypotension when switching to BCP, and hypotension may occur frequently in patients with high baseline BP.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ann Hee You
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.S.); (D.Y.K.); (Y.L.); (H.Y.K.); (J.-H.C.); (Y.K.); (M.K.K.)
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Datta R, Dhar M, Setlur R, Lamba N. Correlation coefficient between plethysmographic variability index and Systolic Pressure Variation as an indicator for fluid responsiveness in hypotensive patients in the ICU/OT. Med J Armed Forces India 2024; 80:52-59. [PMID: 38261854 PMCID: PMC10793231 DOI: 10.1016/j.mjafi.2021.06.026] [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: 01/26/2021] [Accepted: 06/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background Prediction of fluid responsiveness in hypotensive patients is a challenge. The correlation between a novel noninvasive dynamic indicator, Pleth Variability Index (PVI ®), and a gold-standard Systolic Pressure Variation (SPV) as a measure of fluid responsiveness was assessed in the Intensive Care Unit (ICU) or Operation Theatre (OT) in a tertiary care hospital. Methods A prospective experimental study was conducted over a span of one year on 100 mechanically ventilated patients with hypotension. Vital parameters along with SPV and PVI ® were recorded before and after a standard volume expansion protocol. A 10% SPV threshold was used to define fluid responders and nonresponders. Results Pearson's correlation graph at baseline showed positive correlation between PVI ® and SPV (r = 0.59, p-value = 0.001). Strength of correlation was comparatively less but still showed positive correlation at 15 (r = 0.39, p-value = 0.009) and 30 (r = 0.404, p-value = 0.004) minutes of fluid bolus. The Bland Altman analysis of baseline values of PVI ® and SPV showed good agreement with a mean bias of 9.05. Percentage change of PVI ® and SPV over 30 min showed a statistically significant positive correlation in the responder group (r = 0.53, p < 0.05). A threshold value of PVI ® more than 18% before volume expansion differentiated fluid responders and nonresponders with a sensitivity of 75% and specificity of 67%, with an area under Receiver Operating Characteristic (ROC) of 0.78. Conclusion A positive correlation exists between SPV and PVI ®, justifying the use of noninvasive PVI ® in a clinical setting of hypotension.
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Affiliation(s)
| | - Mridul Dhar
- Assistant Professor (Anesthesiology & Critical Care), AIIMS, Rishikesh, India
| | - Rangraj Setlur
- Professor & Head, Department of Anesthesiology, Armed Forces Medical College, Pune, India
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Mladinov D, Isaza E, Gosling AF, Clark AL, Kukreja J, Brzezinski M. Perioperative Fluid Management. Anesthesiol Clin 2023; 41:613-629. [PMID: 37516498 DOI: 10.1016/j.anclin.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
The medical complexity of the geriatric patients has been steadily rising. Still, as outcomes of surgical procedures in the elderly are improving, centers are pushing boundaries. There is also a growing appreciation of the importance of perioperative fluid management on postoperative outcomes, especially in the elderly. Optimal fluid management in this cohort is challenging due to the combination of age-related physiological changes in organ function, increased comorbid burden, and larger fluid shifts during more complex surgical procedures. The current state-of-the-art approach to fluid management in the perioperative period is outlined.
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Affiliation(s)
- Domagoj Mladinov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, CWN-L1, Boston, MA 02115, USA
| | - Erin Isaza
- University of California, San Francisco, School of Medicine, 500 Parnassus Avenue, MU 405 W San Francisco, CA 94143, USA
| | - Andre F Gosling
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, JT 845D, Birmingham, AL 35249, USA
| | - Adrienne L Clark
- Department of Anesthesia and Perioperative Care, University of California, 500 Parnassus Avenue, MU 405 W San Francisco, CA 94143, USA
| | - Jasleen Kukreja
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, 500 Parnassus Avenue, MU 405 W San Francisco, CA 94143, USA
| | - Marek Brzezinski
- Department of Anesthesia and Perioperative Care, University of California, VA Medical Center-San Francisco, 4150 Clement Street, San Francisco CA 94121, USA.
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Zhuang C, Yang R, Xu Y, Song Y, Zhang Y, Liu J, Yang F, Huang X, Liu J, Wang X, Wang Y, Wang L. The Safety Assessment of Irrigation Fluid Management for Shoulder Arthroscopy and Its Effect on Postoperative Efficacy. Orthop Surg 2023; 15:2016-2024. [PMID: 36573289 PMCID: PMC10432476 DOI: 10.1111/os.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE Fluid extravasation is a potentially dangerous complication associated with shoulder arthroscopy. Most relevant studies have involved respiratory system, while the primary purpose was to reveal the effects of the fluid extravasation on cardiovascular system and postoperative function. METHODS The clinical data of 92 patients was retrospective analyzed, in which 84 cases with rotator cuff injury, three cases with shoulder instability, three cases with fractures of the greater tuberosity of the humerus, and two cases with frozen shoulder. All the patients were undergoing shoulder arthroscopy. The relationship between the basic information of the patients and cardiac index (CI) or pulse pressure variation (PPV) were evaluated by linear regression analysis. The change of CI or PPV at different states were evaluated by the one-way analysis of variance. The liquid retention (TR) and postoperative clinical outcomes was analyzed using linear regression. RESULTS The preoperative CI was affected by anesthesia status and body position, while PPV was not affected. Multivariate mixed-effects model analysis of CI found that there was a statistically significant difference in groups of older than 55 years old and those with obesity (BMI > 24). After the operation, the retention of irrigation fluid significantly influenced the circumference of the deltoid (P < 0.001 (95%CI: [0.30, 1.00])), but not on the circumference of the deltoid, neck, and arm. The multivariate analysis of the American Shoulder and Elbow Surgery (ASES) scores at 3 and 6 months after surgery showed that the fluid retention volume was correlated with the ASES score at 3 months after surgery, especially when the retention volume was greater than 2 L (P = 0.001 (95%). %CI: [-12.49, -3.22]). CONCLUSION The retention of irrigation fluid after shoulder arthroscopic surgery causes swelling of local limbs, and has an effect on peripheral blood vessels, which is mainly reflected in its influence on PPV and the postoperative function. Therefore, surgeons need to improve their surgical technique, shorten the operation time and reduce fluid retention.
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Affiliation(s)
- Chengyu Zhuang
- Department of Orthopedics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Renhao Yang
- Department of Orthopedics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yang Xu
- Department of Orthopedics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yanyan Song
- Department of Biostatistics, Clinical Research InstituteShanghai JiaoTong University School of medicineShanghaiChina
| | - Yin Zhang
- Department of Orthopedics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jingfeng Liu
- Department of Orthopedics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Fan Yang
- Department of Anesthesiology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xiaohong Huang
- Department of Operating Room, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jia Liu
- Department of Operating Room, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xiaoning Wang
- Department of Operating Room, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ying Wang
- Department of Anesthesiology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lei Wang
- Department of Orthopedics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Wang Y, Zhang Y, Zheng J, Dong X, Wu C, Guo Z, Wu X. Intraoperative pleth variability index-based fluid management therapy and gastrointestinal surgical outcomes in elderly patients: a randomised controlled trial. Perioper Med (Lond) 2023; 12:16. [PMID: 37173788 PMCID: PMC10182655 DOI: 10.1186/s13741-023-00308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/08/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Intraoperative goal-directed fluid therapy (GDFT) has been reported to reduce postoperative complications of patients undergoing major abdominal surgery. The clinical benefits of pleth variability index (PVI)-directed fluid management for gastrointestinal (GI) surgical patients remain unclear. Therefore, this study aimed to evaluate the impact of PVI-directed GDFT on GI surgical outcomes in elderly patients. METHODS This randomised controlled trial was conducted in two university teaching hospitals from November 2017 to December 2020. In total, 220 older adults undergoing GI surgery were randomised to the GDFT or conventional fluid therapy (CFT) group (n = 110 each). The primary outcome was a composite of complications within 30 postoperative days. The secondary outcomes were cardiopulmonary complications, time to first flatus, postoperative nausea and vomiting, and postoperative length of stay. RESULTS The total volumes of fluid administered were less in the GDFT group than in the CFT group (2.075 L versus [vs.] 2.5 L, P = 0.008). In intention-to-treat analysis, there was no difference in overall complications between the CFT group (41.3%) and GDFT group (43.0%) (odds ratio [OR] = 0.935; 95% confidence interval [CI], 0.541-1.615; P = 0.809). The proportion of cardiopulmonary complications was higher in the CFT group than in the GDFT group (19.2% vs. 8.4%; OR = 2.593, 95% CI, 1.120-5.999; P = 0.022). No other differences were identified between the two groups. CONCLUSIONS Among elderly patients undergoing GI surgery, intraoperative GDFT based on the simple and non-invasive PVI did not reduce the occurrence of composite postoperative complications but was associated with a lower cardiopulmonary complication rate than usual fluid management. TRIAL REGISTRATION This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-17012220) on 1 August 2017.
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Affiliation(s)
- Yu Wang
- Department of Anaesthesiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Yue Zhang
- Clinical Research Institute, Shenzhen-Peking University, The Hong Kong University of Science & Technology Medical Center, Shenzhen, China
| | - Jin Zheng
- Department of Anaesthesiology, Yuebei People's Hospital, Shaoguan, China
| | - Xue Dong
- Department of Anaesthesiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Caineng Wu
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhijia Guo
- Department of Anaesthesiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinhai Wu
- Department of Anaesthesiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China.
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Trauzeddel RF, Leitner M, Dehé L, Nordine M, Piper SK, Habicher M, Sander M, Perka C, Treskatsch S. Goal-directed fluid therapy using uncalibrated pulse contour analysis and balanced crystalloid solutions during hip revision arthroplasty: a quality implementation project. J Orthop Surg Res 2023; 18:281. [PMID: 37024966 PMCID: PMC10078091 DOI: 10.1186/s13018-023-03738-0] [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: 05/03/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND To implement a goal-directed fluid therapy (GDFT) protocol using crystalloids in hip revision arthroplasty surgery within a quality management project at a tertiary hospital using a monocentric, prospective observational study. METHODS Adult patients scheduled for elective hip revision arthroplasty surgery were screened for inclusion in this prospective study. Intraoperatively stroke volume (SV) was optimized within a previously published protocol using uncalibrated pulse contour analysis and balanced crystalloids. Quality of perioperative GDFT was assessed by protocol adherence, SV increase as well as the rate of perioperative complications. Findings were then compared to two different historical groups of a former trial: one receiving GDFT with colloids (prospective colloid group) and one standard fluid therapy (retrospective control group) throughout surgery. Statistical analysis constitutes exploratory data analyses and results are expressed as median with 25th and 75th percentiles, absolute and relative frequencies, and complication rates are further given with 95% confidence intervals for proportions using the normal approximation without continuity correction. RESULTS Sixty-six patients underwent GDFT using balanced crystalloids and were compared to 130 patients with GDFT using balanced colloids and 130 controls without GDFT fluid resuscitation. There was a comparable increase in SV (crystalloids: 65 (54-74 ml; colloids: 67.5 (60-75.25 ml) and total volume infused (crystalloids: 2575 (2000-4210) ml; colloids: 2435 (1760-3480) ml; and controls: 2210 (1658-3000) ml). Overall perioperative complications rates were similar (42.4% (95%CI 30.3-55.2%) for crystalloids and 49.2% (95%CI 40.4-58.1%) for colloids and lower compared to controls: 66.9% (95%CI 58.1-74.9)). Interestingly, a reduced number of hemorrhagic complications was observed within crystalloids: 30% (95%CI 19.6-42.9); colloids: 43% (95%CI 34.4-52.0); and controls: 62% (95%CI 52.6-69.9). There were no differences in the rate of admission to the post-anesthesia care unit or intensive care unit as well as the length of stay. CONCLUSIONS Perioperative fluid management using a GDFT protocol with crystalloids in hip revision arthroplasty surgery was successfully implemented in daily clinical routine. Perioperative complications rates were reduced compared to a previous management without GDFT and comparable when using colloids. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01753050.
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Affiliation(s)
- R F Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - M Leitner
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - L Dehé
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - M Nordine
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - S K Piper
- Institute of Medical Informatics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - M Habicher
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Germany
| | - M Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Germany
| | - C Perka
- Center for Musculoskeletal Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Virchow-Klinikum, Charitéplatz 1, 10117, Berlin, Germany
| | - S Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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Desgranges FP, Bouvet L, Pereira de Souza Neto E, Evain JN, Terrisse H, Joosten A, Desebbe O. Non-invasive measurement of digital plethysmographic variability index to predict fluid responsiveness in mechanically ventilated children: A systematic review and meta-analysis of diagnostic test accuracy studies. Anaesth Crit Care Pain Med 2023; 42:101194. [PMID: 36640908 DOI: 10.1016/j.accpm.2023.101194] [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: 08/29/2022] [Revised: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND To date, the use of the plethysmographic variability index (PVI) has not been recommended to guide fluid management in the paediatric surgical population. This systematic review and meta-analysis aimed to summarise available evidence about the diagnostic accuracy of digital PVI to predict fluid responsiveness in mechanically ventilated children. METHODS We searched the Pubmed, Embase and Web of Science databases, from inception to January 2022, to identify all relevant studies that investigated the ability of the PVI recorded at the finger to predict fluid responsiveness in mechanically ventilated children. Using a random-effects model, we calculated pooled values of diagnostic odds ratio, sensitivity, and specificity of PVI to predict the response to fluid challenge. RESULTS Eight studies met the inclusion criteria with a total of 283 patients and 360 fluid challenges. All the studies were carried out in a surgical setting. The area under the summary receiver operating characteristic curve of PVI to predict fluid responsiveness was 0.82. The pooled sensitivity, specificity, and diagnostic odds ratio of PVI for the overall population were 72.4% [95% CI: 65.3-78.7], 65.9% [58.5-72.8], and 9.26 [5.31-16.16], respectively. CONCLUSION Our results suggest that digital PVI is a reliable predictor for fluid responsiveness in mechanically ventilated children in the perioperative setting. The diagnostic performance of digital PVI reported in our work for discrimination between responders and non-responders to the fluid challenge was however not as high as previously reported in the adult population.
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Affiliation(s)
- François-Pierrick Desgranges
- Department of Anaesthesiology, L'Hôpital Nord-Ouest, Villefranche-sur-Saône Hospital, Villefranche-sur-Saône, France.
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France; Research Unit APCSe VetAgro Sup UPSP 2016.A101, Claude Bernard Lyon 1 University, Marcy-l'Etoile, France
| | | | - Jean-Noël Evain
- Department of Anaesthesiology and Intensive Care, Grenoble Alpes University Hospital, Grenoble, France; Alps Research Assessment and Simulation Centre, Grenoble Alpes University Hospital, Grenoble, France; TIMC-IMAG Laboratory, UMR, CNRS 5525, Grenoble Alpes University, Grenoble, France
| | - Hugo Terrisse
- Department of Biostatistics, Grenoble Alpes University Hospital, Grenoble, France; TIMC-IMAG Laboratory, UMR, CNRS 5525, Grenoble Alpes University, Grenoble, France
| | - Alexandre Joosten
- Department of Anesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Villejuif, France
| | - Olivier Desebbe
- Department of Anaesthesiology and Intensive Care, Ramsay Santé, Sauvegarde Clinic, Lyon, France
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Jessen MK, Vallentin MF, Holmberg MJ, Bolther M, Hansen FB, Holst JM, Magnussen A, Hansen NS, Johannsen CM, Enevoldsen J, Jensen TH, Roessler LL, Lind PC, Klitholm MP, Eggertsen MA, Caap P, Boye C, Dabrowski KM, Vormfenne L, Høybye M, Henriksen J, Karlsson CM, Balleby IR, Rasmussen MS, Pælestik K, Granfeldt A, Andersen LW. Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis. Br J Anaesth 2022; 128:416-433. [PMID: 34916049 PMCID: PMC8900265 DOI: 10.1016/j.bja.2021.10.046] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/28/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes. METHODS Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least one patient-centred postoperative outcome. PubMed and Embase were searched for relevant articles on March 8, 2021. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. The primary outcomes were mortality and hospital length of stay, whereas 15 postoperative complications were included based on availability. From a main pool of comparable trials, meta-analyses were performed on trials with homogenous outcome definitions. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS The main pool consisted of 76 trials with intermediate risk of bias for most outcomes. Overall, goal-directed haemodynamic therapy might reduce mortality (odds ratio=0.84; 95% confidence interval [CI], 0.64 to 1.09) and shorten length of stay (mean difference=-0.72 days; 95% CI, -1.10 to -0.35) but with low certainty in the evidence. For both outcomes, larger effects favouring goal-directed haemodynamic therapy were seen in abdominal surgery, very high-risk surgery, and using targets based on preload variation by the respiratory cycle. However, formal tests for subgroup differences were not statistically significant. Goal-directed haemodynamic therapy decreased risk of several postoperative outcomes, but only infectious outcomes and anastomotic leakage reached moderate certainty of evidence. CONCLUSIONS Goal-directed haemodynamic therapy during general anaesthesia might decrease mortality, hospital length of stay, and several postoperative complications. Only infectious postoperative complications and anastomotic leakage reached moderate certainty in the evidence.
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Affiliation(s)
- Marie K Jessen
- Research Center for Emergency Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mikael F Vallentin
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Mathias J Holmberg
- Research Center for Emergency Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | - Maria Bolther
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Johanne M Holst
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niklas S Hansen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Thomas H Jensen
- Department of Internal Medicine, University Hospital of North Norway, Narvik, Norway
| | - Lara L Roessler
- Department of Emergency Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Peter C Lind
- Department of Surgical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Maibritt P Klitholm
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mark A Eggertsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Philip Caap
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Caroline Boye
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karol M Dabrowski
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Lasse Vormfenne
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Høybye
- Research Center for Emergency Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeppe Henriksen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Carl M Karlsson
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Ida R Balleby
- National Hospital of the Faroe Islands, Torshavn, Faroe Islands, Denmark
| | - Marie S Rasmussen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Kim Pælestik
- Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Asger Granfeldt
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Lars W Andersen
- Research Center for Emergency Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
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Coutrot M, Dudoignon E, Joachim J, Gayat E, Vallée F, Dépret F. Perfusion index: Physical principles, physiological meanings and clinical implications in anaesthesia and critical care. Anaesth Crit Care Pain Med 2021; 40:100964. [PMID: 34687923 DOI: 10.1016/j.accpm.2021.100964] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
Photoplethysmography (PPG) has been extensively used for pulse oximetry monitoring in anaesthesia, perioperative and intensive care. However, some components of PPG signal have been employed for other purposes, such as non-invasive haemodynamic monitoring. Perfusion index (PI) is derived from PPG signal and represents the ratio of pulsatile on non-pulsatile light absorbance or reflectance of the PPG signal. PI determinants are complex and interlinked, involving and reflecting the interaction between peripheral and central haemodynamic characteristics, such as vascular tone and stroke volume. Recently, several studies have shed light on the interesting performances of this variable, especially assessing regional or neuraxial block success, and haemodynamic monitoring in anaesthesia, perioperative and intensive care. Nevertheless, no review has yet been published concerning the interest of PI in these fields. In this narrative review will be exposed first the physiological and pathophysiological determinants of PI, and then the mean to measure this value as well as its potential limitations. In the second part, the existing data concerning usefulness of PI in different clinical settings such as operating theatres, intensive care units and emergency departments will be presented and discussed. Finally, the perspectives concerning the use of PI and mentioned aspects that should be explored regarding this tool will be underlined.
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Affiliation(s)
- Maxime Coutrot
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; FHU PROMICE, Paris, France.
| | - Emmanuel Dudoignon
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France.
| | - Jona Joachim
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France
| | - Etienne Gayat
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), France; FHU PROMICE, Paris, France
| | - Fabrice Vallée
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), France; FHU PROMICE, Paris, France; Inria, France; LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, France
| | - François Dépret
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), France; FHU PROMICE, Paris, France; F-CRIN INICRCT network, Paris, France
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12
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Hasanin AM, Mostafa MM, Abdulatif M. Comment on: "Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial". J Clin Anesth 2021; 75:110557. [PMID: 34662831 DOI: 10.1016/j.jclinane.2021.110557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ahmed M Hasanin
- Department of Anaesthesia and critical care medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Maha M Mostafa
- Department of Anaesthesia and critical care medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Abdulatif
- Department of Anaesthesia and critical care medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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13
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Desgranges FP, Zorio V, Jacquet-Lagreze M, Lilot M. Plethysmographic variability index to predict fluid responsiveness in the general surgical paediatric population. Anaesth Crit Care Pain Med 2021; 40:100955. [PMID: 34626865 DOI: 10.1016/j.accpm.2021.100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Violette Zorio
- Department of Anaesthesiology, Hospices Civils de Lyon, Lyon, France
| | | | - Marc Lilot
- Department of Anaesthesiology, Hospices Civils de Lyon, Lyon, France
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de Waal EEC, Frank M, Scheeren TWL, Kaufmann T, de Korte-de Boer D, Cox B, van Kuijk SMJ, Montenij LM, Buhre W. Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial. J Clin Anesth 2021; 75:110506. [PMID: 34536718 DOI: 10.1016/j.jclinane.2021.110506] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/29/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE The potential of perioperative goal-directed therapy (PGDT) to improve outcome after high-risk abdominal surgery remains subject of debate. In particular, there is a need for large, multicenter trials focusing on relevant patient outcomes to confirm the evidence found in small, single center studies including minor complications in their composite endpoints. The present study therefore aims to investigate the effect of an arterial waveform analysis based PGDT algorithm on the incidence of major complications including mortality after high-risk abdominal surgery. DESIGN Prospective randomized controlled multicenter trial. SETTING Operating theatres and Post-Anesthesia/Intensive Care units (PACU/ICU) of four tertiary hospitals in The Netherlands. PATIENTS A total number of 482 patients undergoing elective, abdominal surgery that is considered high-risk due to the extent of the procedure and/or patient comorbidities. INTERVENTIONS Hemodynamic therapy using an age-specific PGDT algorithm including cardiac index (CI) and stroke volume variation (SVV) measurements during a 24-h perioperative period starting at induction of anesthesia. MEASUREMENTS The average number of major complications (including mortality) within 30 days after surgery, the number of minor complications, hospital and PACU/ICU length of stay (LOS), amounts of fluids and vasoactive medications used. Complications were graded using the Accordion severity grading system. RESULTS The average number of major complications per patient was 0.79 (PGDT group) versus 0.69 (control group) (p = 0.195). There were no statistically significant differences in the number of minor complications, hospital LOS, PACU/ICU LOS, or grading of complications. Patients in the PGDT group received more fluids intraoperatively, more dobutamine intra- and postoperatively, while patients in the control group received more phenylephrine during the operation. CONCLUSIONS PGDT based on a CI and SVV driven algorithm did not result in improved outcomes after high-risk abdominal surgery. CLINICAL TRIAL REGISTRATION Netherlands Trial Registry: NTR3380.
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Affiliation(s)
- Eric E C de Waal
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Michael Frank
- Department of Anesthesiology and Intensive Care, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Thomas Kaufmann
- Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Dianne de Korte-de Boer
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Boris Cox
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - L M Montenij
- Department of Anesthesiology and Intensive Care, Catharina Ziekenhuis, Eindhoven, the Netherlands.
| | - Wolfgang Buhre
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands.
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15
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16
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Pleth Variability Index in Orthopedic Surgery: Reply. Anesthesiology 2021; 134:502-503. [PMID: 33301556 DOI: 10.1097/aln.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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19
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Manecke G. Volume Responsiveness: What It Does Not Tell Us. J Cardiothorac Vasc Anesth 2021; 35:1307-1309. [PMID: 33455888 DOI: 10.1053/j.jvca.2020.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Gerard Manecke
- Department of Anesthesiology, University of California San Diego, Veterans Affairs Medical Center San Diego, San Diego, CA.
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20
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Roy TK, Secomb TW. Effects of impaired microvascular flow regulation on metabolism-perfusion matching and organ function. Microcirculation 2020; 28:e12673. [PMID: 33236393 DOI: 10.1111/micc.12673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
Impaired tissue oxygen delivery is a major cause of organ damage and failure in critically ill patients, which can occur even when systemic parameters, including cardiac output and arterial hemoglobin saturation, are close to normal. This review addresses oxygen transport mechanisms at the microcirculatory scale, and how hypoxia may occur in spite of adequate convective oxygen supply. The structure of the microcirculation is intrinsically heterogeneous, with wide variations in vessel diameters and flow pathway lengths, and consequently also in blood flow rates and oxygen levels. The dynamic processes of structural adaptation and flow regulation continually adjust microvessel diameters to compensate for heterogeneity, redistributing flow according to metabolic needs to ensure adequate tissue oxygenation. A key role in flow regulation is played by conducted responses, which are generated and propagated by endothelial cells and signal upstream arterioles to dilate in response to local hypoxia. Several pathophysiological conditions can impair local flow regulation, causing hypoxia and tissue damage leading to organ failure. Therapeutic measures targeted to systemic parameters may not address or may even worsen tissue oxygenation at the microvascular level. Restoration of tissue oxygenation in critically ill patients may depend on restoration of endothelial cell function, including conducted responses.
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Affiliation(s)
- Tuhin K Roy
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Timothy W Secomb
- Department of Physiology, University of Arizona, Tucson, AZ, 85724, USA
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21
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Zorrilla-Vaca A, Mena GE, Ripolles-Melchor J, Abad-Motos A, Aldecoa C, Lorente JV, Ramirez-Rodriguez JM, Grant MC. Goal-Directed Fluid Therapy and Postoperative Outcomes in an Enhanced Recovery Program for Colorectal Surgery: A Propensity Score-Matched Multicenter Study. Am Surg 2020; 87:1189-1195. [PMID: 33342254 DOI: 10.1177/0003134820973365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Goal-directed fluid therapy (GDFT) has increasingly been utilized in major surgery as a key component to ensure fluid optimization and adequate tissue perfusion, showing improvements in the rate of morbidity and mortality under conventional care. It is unclear if patients derive similar benefit as part of an enhanced recovery program (ERP). Our group sought to assess the association between GDFT and postoperative outcomes within an ERP for colorectal surgery. METHODS A propensity score-matched analysis, based upon demographic characteristics, comorbidities, and ERP components, was utilized to assess the association between GDFT and outcomes in a multicenter prospective ERP for colorectal surgery cohort study. Outcomes included pulmonary edema, acute kidney injury (AKI), ileus, surgical site infection (SSI), and anastomotic dehiscence. The calipmatch module was used to match patients who received GDFT to non-GDFT in a 1-to-1 propensity score fashion. RESULTS A total of 151 matched pairs were included in the analysis (n = 302, 23%). Both groups had comparable baseline demographics, as well as similar rates of compliance with enhanced recovery after surgery (ERAS) components. Goal-directed fluid therapy patients received significantly more colloid (237 ± 320 mL vs. 140 ± 245 mL, P < .01) than non-GDFT counterparts. Goal-directed fluid therapy was not associated with improved rates of postoperative AKI (odds ratios (OR) 1.00, 95% confidence intervals (CI) .39-2.59, P = 1.00), ileus (OR 1.40, 95% CI .82-2.41, P = .22), SSI (OR 1.06, 95% CI .54-2.08, P = .86), or length of hospital stay (LOS) (10.8 ± 8.9 vs. 11.1±13.2 days, P = .84). CONCLUSIONS There was no associated between GDFT and major postoperative outcomes within an ERAS program for colorectal surgery. Additional large-scale or pragmatic randomized trials are necessary to determine whether GDFT has a role in ERP for colorectal surgery.
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Affiliation(s)
- Andres Zorrilla-Vaca
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, 4002University of Texas, TX, USA.,Department of Anesthesiology, Universidad del Valle, CO, USA
| | - Gabriel E Mena
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, 4002University of Texas, TX, USA
| | | | - Ane Abad-Motos
- Department of Anesthesia and Critical Care, 145708Infanta Leonor University Hospital, Spain
| | - Cesar Aldecoa
- Department of Anesthesiology, 16918Hospital Universitario Río Hortega, Spain
| | | | - José M Ramirez-Rodriguez
- Department of Surgery, Department of General Surgery, 16479Hospital Clínico Universitario Lozano Blesa, Spain
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, 1501Johns Hopkins Hospital, MD, USA
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Berger S, Poignant E, Jacquet-Lagrèze M, Fellahi JL. Comparison of Rainbow Pleth Variability Index and Pleth Variability Index in mechanically ventilated patients under general anaesthesia. Anaesth Crit Care Pain Med 2020; 40:100735. [PMID: 32949765 DOI: 10.1016/j.accpm.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Simon Berger
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, France
| | - Elizabeth Poignant
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, France
| | - Matthias Jacquet-Lagrèze
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, France; Faculté de Médecine Lyon Est, Inserm U1060, Université Claude Bernard Lyon 1, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, France; Faculté de Médecine Lyon Est, Inserm U1060, Université Claude Bernard Lyon 1, France.
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Joosten A, Coeckelenbergh S, Alexander B, Delaporte A, Cannesson M, Duranteau J, Saugel B, Vincent JL, Van der Linden P. Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review. BMC Anesthesiol 2020; 20:209. [PMID: 32819296 PMCID: PMC7441629 DOI: 10.1186/s12871-020-01128-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/12/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Perioperative fluid management - including the type, dose, and timing of administration -directly affects patient outcome after major surgery. The objective of fluid administration is to optimize intravascular fluid status to maintain adequate tissue perfusion. There is continuing controversy around the perioperative use of crystalloid versus colloid fluids. Unfortunately, the importance of fluid volume, which significantly influences the benefit-to-risk ratio of each chosen solution, has often been overlooked in this debate. MAIN TEXT The volume of fluid administered during the perioperative period can influence the incidence and severity of postoperative complications. Regrettably, there is still huge variability in fluid administration practices, both intra-and inter-individual, among clinicians. Goal-directed fluid therapy (GDFT), aimed at optimizing flow-related variables, has been demonstrated to have some clinical benefit and has been recommended by multiple professional societies. However, this approach has failed to achieve widespread adoption. A closed-loop fluid administration system designed to assist anesthesia providers in consistently applying GDFT strategies has recently been developed and tested. Such an approach may change the crystalloid versus colloid debate. Because colloid solutions have a more profound effect on intravascular volume and longer plasma persistence, their use in this more "controlled" context could be associated with a lower fluid balance, and potentially improved patient outcome. Additionally, most studies that have assessed the impact of a GDFT strategy on the outcome of high-risk surgical patients have used hydroxyethyl starch (HES) solutions in their protocols. Some of these studies have demonstrated beneficial effects, while none of them has reported severe complications. CONCLUSIONS The type and volume of fluid used for perioperative management need to be individualized according to the patient's hemodynamic status and clinical condition. The amount of fluid given should be guided by well-defined physiologic targets. Compliance with a predefined hemodynamic protocol may be optimized by using a computerized system. The type of fluid should also be individualized, as should any drug therapy, with careful consideration of timing and dose. It is our perspective that HES solutions remain a valid option for fluid therapy in the perioperative context because of their effects on blood volume and their reasonable benefit/risk profile.
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Affiliation(s)
- Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
- Department of Anesthesiology & Perioperative Medicine, Bicêtre Hospital, 78, Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Sean Coeckelenbergh
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brenton Alexander
- Department of Anesthesiology & Perioperative Care, University of California San Diego, San Diego, USA
| | - Amélie Delaporte
- Department of Anesthesiology & Intensive Care, Marie Lannelongue Hospital, Paris, France
| | - Maxime Cannesson
- Department of Anesthesiology & Perioperative Medicine, University of California Los Angeles, Los Angeles, USA
| | - Jacques Duranteau
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Outcomes Research Consortium, Cleveland, OH USA
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Van der Linden
- Department of Anesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
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25
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Joosten A, Vincent JL, Saugel B. Continuous non-invasive haemodynamic monitoring in patients having surgery: Valuable tool or superfluous toy? Anaesth Crit Care Pain Med 2020; 39:417-418. [PMID: 32499128 DOI: 10.1016/j.accpm.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alexandre Joosten
- Department of Anaesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France.
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernd Saugel
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, Ohio, USA
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