1
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Han S, Wu X, Li P, He K, Li J. The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis. J Cardiothorac Surg 2024; 19:60. [PMID: 38317166 PMCID: PMC10840200 DOI: 10.1186/s13019-024-02519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/28/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing major abdominal surgery. However, whether GDFT could reduce the incidence of PPCs in patients undergoing thoracic surgery was unclear. The present meta-analysis was designed to assess the impact of Goal-directed Fluid Therapy on PPCs in patients undergoing thoracic surgery. METHODS Randomized controlled trials (RCTs) comparing GDFT with other conventional fluid management strategies in adult patients undergoing thoracic surgery were identified. Databases searched included PubMed, Web of Science, Embase, and Cochrane Library databases. Review Manager 5.4 (The Cochrane Collaboration, Oxford, UK) software was used for statistical analysis. Heterogeneity was analyzed using I2 statistics, and a standardized mean difference with 95% CI and P value was used to calculate the treatment effect for outcome variables. The primary study outcomes were the incidence of PPCs. Secondary outcomes were the total volume infused, the length of hospitalization, the incidence of cardiac complications, and the incidence of renal dysfunction. Subgroup analysis was planned to verify the definite role of GDFT. RESULTS A total of 6 RCTs consisting of 680 patients were included in this meta-analysis, which revealed that GDFT did not reduce the incidence of PPCs in patients undergoing thoracic surgery (RR, 0.57; 95% CI 0.29-1.14). However, GDFT decreased the total intra-operative fluid input (MD, - 244.40 ml; 95% CI - 397.06 to - 91.74). There was no statistical difference in the duration of hospitalization (MD; - 1.31, 95% CI - 3.00 to 0.38), incidence of renal dysfunction (RR, 0.62; 95% CI 0.29-1.35), and incidence of cardiac complications (RR, 0.62; 95% CI 0.27-1.40). CONCLUSIONS The results of this meta-analysis indicate that GDFT did not reduce the postoperative incidence of pulmonary complications in individuals undergoing thoracic surgery. However, considering the small number of contributing studies, these results should be interpreted with caution.
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Affiliation(s)
- Shuang Han
- Department of Anesthesiology, Hebei General Hospital, No.348, Heping West Road, Shijiazhuang, 050051, China
| | - Xiaoqian Wu
- Department of Anesthesiology, Hebei General Hospital, No.348, Heping West Road, Shijiazhuang, 050051, China
| | - Pan Li
- Department of Anesthesiology, Hebei General Hospital, No.348, Heping West Road, Shijiazhuang, 050051, China
| | - Kun He
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, No.16, Tangu North Street, Shijiazhuang, 050051, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, No.348, Heping West Road, Shijiazhuang, 050051, China.
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2
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Li X, Zhang Q, Zhu Y, Yang Y, Xu W, Zhao Y, Liu Y, Xue W, Fang Y, Huang J. Effect of perioperative goal-directed fluid therapy on postoperative complications after thoracic surgery with one-lung ventilation: a systematic review and meta-analysis. World J Surg Oncol 2023; 21:297. [PMID: 37723513 PMCID: PMC10506328 DOI: 10.1186/s12957-023-03169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/02/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND An understanding of the impact of goal-directed fluid therapy (GDFT) on the outcomes of patients undergoing one-lung ventilation (OLV) for thoracic surgery remains incomplete and controversial. This meta-analysis aimed to assess the effect of GDFT compared to other fluid therapy strategies on the incidence of postoperative complications in patients with OLV. METHODS The Embase, Cochrane Library, Web of Science, and MEDLINE via PubMed databases were searched from their inception to November 30, 2022. Forest plots were constructed to present the results of the meta-analysis. The quality of the included studies was evaluated using the Cochrane Collaboration tool and Risk Of Bias In Non-Randomized Study of Interventions (ROBINS-I). The primary outcome was the incidence of postoperative complications. Secondary outcomes were the length of hospital stay, PaO2/FiO2 ratio, total fluid infusion, inflammatory factors (TNF-α, IL-6), and postoperative bowel function recovery time. RESULTS A total of 1318 patients from 11 studies were included in this review. The GDFT group had a lower incidence of postoperative complications [odds ratio (OR), 0.47; 95% confidence interval (95% CI), 0.29-0.75; P = 0.002; I 2, 67%], postoperative pulmonary complications (OR 0.48, 95% CI 0.27-0.83; P = 0.009), and postoperative anastomotic leakage (OR 0.51, 95% CI 0.27-0.97; P = 0.04). The GDFT strategy reduces total fluid infusion. CONCLUSIONS GDFT is associated with lower postoperative complications and better survival outcomes after thoracic surgery for OLV.
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Affiliation(s)
- Xuan Li
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China
| | - Qinyu Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China
| | - Yuyang Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China
| | - Yihan Yang
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China
| | - Wenxia Xu
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China
| | - Yufei Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China
| | - Yuan Liu
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China
| | - Wenqiang Xue
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China
| | - Yu Fang
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China.
| | - Jie Huang
- Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China.
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3
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Sontakke MG, Sontakke NG, Parihar AS. Fluid Resuscitation in Patients With Traumatic Brain Injury: A Comprehensive Review. Cureus 2023; 15:e43680. [PMID: 37724238 PMCID: PMC10505263 DOI: 10.7759/cureus.43680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Patients with traumatic brain injury (TBI) or head trauma present challenges for emergency physicians and neurosurgeons. Traumatic brain injury is currently a community health issue. For the best possible care, it is crucial to understand the various helpful therapy techniques in the pre-operative and pre-hospital phases. The initial rapid infusion of large volumes of mannitol and a hypertonic crystalloid solution to restore blood pressure and blood volume is the current standard of care for people with combined hemorrhagic shock (HS) and traumatic brain injury. The selection and administration of fluids to trauma and traumatic brain injury patients may be especially helpful in preventing subsequent ischemic brain damage because of the hemodynamic stabilizing effects of these fluids in hypovolemic shock. Traumatic brain injury is an essential factor that may lead to disability and death in a patient. Traumatic brain damage can develop either as a direct result of the trauma or as a result of the initial harm. Significant neurologic problems, such as cranial nerve damage, dementia, seizures, and Alzheimer's disease, can develop after a traumatic brain injury. The comorbidity of the victims may also be significantly increased by additional psychiatric problems such as psychological diseases and other behavioral and cognitive sequels. We review the history of modern fluid therapy, complications after traumatic brain injury, and the use of fluid treatment for decompressive craniectomy and traumatic brain injury.
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Affiliation(s)
- Mayuri G Sontakke
- Accident Trauma Care and Technology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhil G Sontakke
- Health Sciences, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akhilesh S Parihar
- Emergency Department, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Pellegrini JAS, Mendes CL, Gottardo PC, Feitosa K, John JF, de Oliveira ACT, Negri AJDA, Grumann AB, Barros DDS, Negri FEFDO, de Macedo GL, Neves JLB, Rodrigues MDS, Spagnól MF, Ferez MA, Chalhub RÁ, Cordioli RL. The use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 - Technical aspects. CRITICAL CARE SCIENCE 2023; 35:117-146. [PMID: 37712802 PMCID: PMC10406406 DOI: 10.5935/2965-2774.20230310-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/12/2023] [Indexed: 09/16/2023]
Abstract
Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
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Affiliation(s)
- José Augusto Santos Pellegrini
- Department of Intensive Care, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Ciro Leite Mendes
- Department of Intensive Care, Hospital Universitário Lauro
Wanderley - João Pessoa (PB), Brazil
| | - Paulo César Gottardo
- Department of Intensive Care, Hospital Nossa Senhora das Neves -
João Pessoa (PB), Brazil
| | - Khalil Feitosa
- Department of Emergency Medicine, Hospital Geral de Fortaleza -
Fortaleza (CE), Brazil
| | - Josiane França John
- Department of Intensive Care, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | - Ana Burigo Grumann
- Department of Intensive Care, Hospital Nereu Ramos -
Florianópolis (SC), Brazil
| | - Dalton de Souza Barros
- Cardiovascular Intensive Care Unit, Hospital Cardiopulmonar
Instituto D’Or - Salvador (BA), Brazil
| | | | | | | | - Márcio da Silveira Rodrigues
- Department of Emergency, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | - Marcus Antonio Ferez
- Intensive Care Unit, Hospital Beneficência Portuguesa -
Ribeirão Preto (SP), Brazil
| | - Ricardo Ávila Chalhub
- Department of Echocardiogram, Hospital Santo Antônio, Obras
Sociais Irmã Dulce - Salvador (BA), Brazil
| | - Ricardo Luiz Cordioli
- Department of Intensive Care, Hospital Israelita Albert Einstein -
São Paulo (SP), Brazil
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5
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Feng A, Lu P, Yang Y, Liu Y, Ma L, Lv J. Effect of goal-directed fluid therapy based on plasma colloid osmotic pressure on the postoperative pulmonary complications of older patients undergoing major abdominal surgery. World J Surg Oncol 2023; 21:67. [PMID: 36849953 PMCID: PMC9970856 DOI: 10.1186/s12957-023-02955-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND As an important component of accelerated rehabilitation surgery, goal-directed fluid therapy (GDT) is one of the optimized fluid therapy strategies and is closely related to perioperative complications and mortality. This article aimed to study the effect of combining plasma colloid osmotic pressure (COP) with stroke volume variation (SVV) as a target for intraoperative GDT for postoperative pulmonary complications in older patients undergoing major abdominal surgery. METHODS In this study, older patients (n = 100) undergoing radical resection of gastroenteric tumors were randomized to three groups: Group C (n1 = 31) received a conventional infusion regimen, Group S1 (n2 = 34) received GDT based on SVV, and Group S2 (n3 = 35) received GDT based on SVV and COP. The results were recorded, including the lung injury score (LIS); PaO2/FiO2 ratio; lactic acid value at the times of beginning (T0) and 1 h (T1), 2 h (T2), and 3 h (T3) after liquid infusion in the operation room; the total liquid infusion volume; infusion volumes of crystalline and colloidal liquids; urine production rate; pulmonary complications 7 days after surgery; and the severity grading of postoperative pulmonary complications. RESULTS The patients in the S2 group had fewer postoperative pulmonary complications than those in the C group (P < 0.05) and the proportion of pulmonary complications of grade 1 and higher than grade 2 in S2 group was significantly lower than that in C group (P <0.05); the patients in the S2 group had a higher PaO2/FiO2 ratio than those in the C group (P < 0.05), lower LIS than those in the S1 and C groups (P < 0.05), less total liquid infusion than those in the C group (P < 0.05), and more colloidal fluid infusion than those in the S1 and C groups (P < 0.05). CONCLUSION The findings of our study show that intraoperative GDT based on COP and SVV can reduce the incidence of pulmonary complications and conducive to shortening the hospital stay in older patients after gastrointestinal surgery. TRIAL REGISTRATION Chinese Clinical Trial. no. ChiCTR2100045671. Registry at www.chictr.org.cn on April 20, 2021.
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Affiliation(s)
- Anqi Feng
- grid.452672.00000 0004 1757 5804Department of Anesthesiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shanxi China
| | - Pan Lu
- grid.452672.00000 0004 1757 5804Department of Anesthesiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shanxi China
| | - Yanan Yang
- grid.452672.00000 0004 1757 5804Department of Anesthesiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shanxi China
| | - Ying Liu
- grid.452672.00000 0004 1757 5804Department of Anesthesiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shanxi China
| | - Lei Ma
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shanxi, China.
| | - Jianrui Lv
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shanxi, China.
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6
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Prasad C, Radhakrishna N, Pandia MP, Khandelwal A, Singh GP, Bithal PK. The Effect of Goal-Directed Fluid Therapy versus Standard Fluid Therapy on the Cuff Leak Gradient in Patients Undergoing Complex Spine Surgery in Prone Position. J Neurosci Rural Pract 2021; 12:745-750. [PMID: 34737510 PMCID: PMC8559088 DOI: 10.1055/s-0041-1735321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective
Cuff leak test is an effective and established maneuver to predict airway edema. Standard fluid therapy (SFT) based on conventional monitoring is often associated with postoperative airway edema after complex spine surgeries. We conducted this prospective randomized controlled study to compare the effect of SFT versus goal-directed fluid therapy (GDFT) on the cuff leak gradient (CLG) in patients undergoing complex spine surgery in prone position. Our secondary objectives were to compare the effect of SFT and GDFT on sore throat, hoarseness, and length of intensive care unit (ICU) and hospital stay.
Materials and Methods
Thirty consecutive American Society of Anesthesiologists physical status I and II patients (18–60 years), of either sex, scheduled for spine surgery in prone position with expected duration of surgery more than 5 hours were included. The patients were randomized into two groups of 15 each. Group S patients (
n
= 15) served as control group and received SFT intraoperatively, while patients in group G (
n
= 15) received GDFT. Standard anesthetic protocol was followed in both the groups. The CLG was defined as the difference between the cuff leak volume (CLV) after intubation (CLV
AI
) and before extubation (CLV
BE
).
Statistical Analysis and Results
CLG was significantly less in group G (group S, 137.12 mL; group G, 65.52 mL;
p
-value <0.001). Intravenous fluids, blood loss, and postoperative sore throat were comparatively lesser in group G, though not statistically significant. Postoperative hoarseness was significantly lower in group G (
p
-value = 0.003). Duration of ICU stay in group G (19.43 hours) was significantly lower (
p
-value = 0.009) than group S (24.64 hours), but length of hospital stay was comparable.
Conclusion
GDFT significantly reduces airway edema and consequently reduces CLG as compared with SFT in patients undergoing complex spine surgery in prone position. Postoperatively, it also reduces sore throat, hoarseness of voice, and duration of ICU stay.
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Affiliation(s)
- Chandrakant Prasad
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nayani Radhakrishna
- Department of Anaesthesia, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Mihir Prakash Pandia
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Khandelwal
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Gyaninder Pal Singh
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Parmod Kumar Bithal
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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7
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Struck MF, Hempel G, Pietsch UC, Broschewitz J, Eichfeld U, Werdehausen R, Krämer S. Thoracotomy for emergency repair of iatrogenic tracheal rupture: single center analysis of perioperative management and outcomes. BMC Anesthesiol 2019; 19:194. [PMID: 31656172 PMCID: PMC6816164 DOI: 10.1186/s12871-019-0869-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/17/2019] [Indexed: 12/25/2022] Open
Abstract
Background Iatrogenic tracheal ruptures are rare but life-threatening airway complications that often require surgical repair. Data on perioperative vital functions and anesthetic regimes are scarce. The goal of this study was to explore comorbidity, perioperative management, complications and outcomes of patients undergoing thoracotomy for surgical repair. Methods We retrospectively evaluated adult patients who required right thoracotomy for emergency surgical repair of iatrogenic posterior tracheal ruptures and were admitted to a university hospital over a 15-year period (2004–2018). The analyses included demographic, diagnostic, management and outcome data on preinjury morbidity and perioperative complications. Results Thirty-five patients who met the inclusion criteria were analyzed. All but two patients (96%) presented with critical underlying diseases and/or emergency tracheal intubations. The median time (interquartile range) from diagnosis to surgery was 0.3 (0.2–1.0) days. The durations of anesthesia, surgery and one-lung ventilation (OLV) were 172 (128–261) min, 100 (68–162) min, and 52 (40–99) min, respectively. The primary airway management approach to OLV was successful in only 12 patients (34%). Major complications during surgery were observed in 10 patients (29%). Four patients (11%) required cardiopulmonary resuscitation, one of whom received extracorporeal membrane oxygenation, and another one of these patients died during surgery. Major complications were associated with significantly higher all-cause 30-day mortality (p = 0.002) and adjusted mortality (p = 0.001) compared to patients with minor or no complications. Conclusions Surgical repair of iatrogenic tracheal ruptures requires advanced perioperative care in a specialized center due to high morbidity and potential complications. Airway management should include early anticipation of alternative OLV approaches to provide acceptable conditions for surgery.
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Affiliation(s)
- Manuel F Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany.
| | - Gunther Hempel
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Uta C Pietsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Johannes Broschewitz
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Uwe Eichfeld
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Robert Werdehausen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Sebastian Krämer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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8
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Klevebro F, Boshier PR, Low DE. Application of standardized hemodynamic protocols within enhanced recovery after surgery programs to improve outcomes associated with anastomotic leak and conduit necrosis in patients undergoing esophagectomy. J Thorac Dis 2019; 11:S692-S701. [PMID: 31080646 PMCID: PMC6503292 DOI: 10.21037/jtd.2018.11.141] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/29/2018] [Indexed: 12/13/2022]
Abstract
Esophagectomy for cancer is associated with high risk for postoperative morbidity. The most serious regularly encountered complication is anastomotic leak and the most feared individual complication is conduit necrosis. Both of these complications affect the length of stay, mortality, quality of life, and survival for patients undergoing esophageal resection. The maintenance of conduit viability is of primary importance in the perioperative care of patients following esophageal resection. It has been shown that restrictive fluid management may be associated with improved postoperative outcomes in abdominal and other types of surgery, but many factors can affect the incidence of anastomotic leak and the viability of the gastric conduit. We have performed a comprehensive review with the aim to give an overview of the available evidence for the use of standardized hemodynamic protocols (SHPs) for esophagectomy and review the hemodynamic protocol, which has been applied within a standardized clinical pathway (SCP) at the Department of Thoracic surgery at the Virginia Mason Medical Center between 2004-2018 where the anastomotic leak rate over the period has been 5.2% and the incidence of conduit necrosis requiring surgical management is zero. The literature review demonstrates that there are few high quality studies that provide scientific evidence for the use of a SHP. The evidence indicates that the use of goal-directed hemodynamic monitoring might be associated with a reduced risk for postoperative complications, shortened length of stay, and decreased need for intensive care unit stay. We propose that the routine application of a SHP can provide a uniform infrastructure to optimize conduit perfusion and decrease the incidence of anastomotic leak.
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Affiliation(s)
- Fredrik Klevebro
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Piers R Boshier
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Donald E Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, USA
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9
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Cheng YW, Xu F, Li J. Identification of volume parameters monitored with a noninvasive ultrasonic cardiac output monitor for predicting fluid responsiveness in children after congenital heart disease surgery. Medicine (Baltimore) 2018; 97:e12289. [PMID: 30278500 PMCID: PMC6181535 DOI: 10.1097/md.0000000000012289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 08/16/2018] [Indexed: 01/23/2023] Open
Abstract
No previous study has used an ultrasonic cardiac output monitor (USCOM) to assess volume parameters, such as stroke volume variation (SVV), in order to predict the volume status and fluid responsivenes in children after congenital heart disease (CHD) surgery. The present prospective trial aimed to investigate the ability of SVV and corrected flow time (FTc), which were assessed with a USCOM, for predicting fluid responsiveness in children after CHD surgery.The study included 60 children who underwent elective CHD surgery. Data were collected after elective CHD surgery. After arrival at PICU, the continuous invasive blood pressure was monitored. Once the blood pressure (BP) decreased to the minimum value, 6% hydroxyethyl starch (130/0.4) was administered (10 mL/kg) over 30 minutes for volume expansion (VE). The USCOM was used to monitor the heart rate, central venous pressure, stroke volume index (SVI), cardiac index, SVV, FTc of the children before and after VE. Additionally, the SVI change (ΔSVI) was calculated, and the inotropic score (IS) was determined. Children with a ΔSVI ≥15% were considered responders, while the others were considered nonresponders. The children were also divided into IS ≤10 and IS >10 groups.Of the 60 children, 32 were responders and 28 were nonresponders. We found that only SVV was significantly correlated with ΔSVI (r = 0.42, P < .01). SVV could predict fluid responsiveness after surgery (area under the curve [AUC]: 0.776, P < .01), and the optimal threshold was 17.04% (sensitivity, 84.4%; specificity, 60.7%). Additionally, the SVV AUC was higher in the IS >10 group than in the IS ≤10 group (0.81 vs 0.73).SVV measured with a USCOM can be used to predict fluid responsiveness after CHD surgery in children. Additionally, the accuracy of SVV for predicting fluid responsiveness might be higher among patients with an IS >10 than among those with an IS ≤10.
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Affiliation(s)
- Yu-wei Cheng
- Department of Emergency of Children's Hospital of Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- Key Laboratory of Pediatrics in Chongqing
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Feng Xu
- Department of PICU of Children's Hospital of Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- Key Laboratory of Pediatrics in Chongqing
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Jing Li
- Department of PICU of Children's Hospital of Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- Key Laboratory of Pediatrics in Chongqing
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
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10
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Abstract
In this review, we will provide an overview of the current state of the art of perioperative practices for open and laparoscopic oesophagus surgery from the anaesthetist's perspective. Morbidity and mortality after oesophagectomy is still high despite multidisciplinary and enhanced recovery pathways showing promising results. The anaesthetist has an important role in the complex care of the oesophageal cancer patient. Minimizing unnecessary fluid administration, adequate pain management, hypotension, and protective lung ventilation are examples of proven strategies that can improve outcome after this high-risk surgery.
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Affiliation(s)
- Denise P Veelo
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Bart F Geerts
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
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11
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Veelo DP, van Berge Henegouwen MI, Ouwehand KS, Geerts BF, Anderegg MCJ, van Dieren S, Preckel B, Binnekade JM, Gisbertz SS, Hollmann MW. Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement study. PLoS One 2017; 12:e0172806. [PMID: 28253353 PMCID: PMC5333843 DOI: 10.1371/journal.pone.0172806] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/09/2017] [Indexed: 12/21/2022] Open
Abstract
Background Goal-directed therapy (GDT) can reduce postoperative complications in high-risk surgery patients. It is uncertain whether GDT has the same benefits in patients undergoing esophageal surgery. Goal of this Quality Improvement study was to evaluate the effects of a stroke volume guided GDT on post-operative outcome. Methods and findings We compared the postoperative outcome of patients undergoing esophagectomy before (99 patients) and after (100 patients) implementation of GDT. There was no difference in the proportion of patients with a complication (56% vs. 54%, p = 0.82), hospital stay and mortality. The incidence of prolonged ICU stay (>48 hours) was reduced (28% vs. 12, p = .005) in patients treated with GDT. Secondary analysis of complication rate showed a decrease in pneumonia (29 vs. 15%, p = .02), mediastinal abscesses (12 vs. 3%, p = .02), and gastric tube necrosis (5% vs. 0%, p = .03) in patients treated with GDT. Patients in the GDT group received significantly less fluids but received more colloids. Conclusions The implementation of GDT during esophagectomy was not associated with reductions in overall morbidity, mortality and hospital length of stay. However, we observed a decrease in pneumonia, mediastinal abscesses, gastric tube necrosis, and ICU length of stay.
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Affiliation(s)
- Denise P. Veelo
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Kirsten S. Ouwehand
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Bart F. Geerts
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | | | - Susan van Dieren
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan M. Binnekade
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Markus W. Hollmann
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
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12
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Della Rocca G, Vetrugno L. Fluid Therapy Today: Where are We? Turk J Anaesthesiol Reanim 2016; 44:233-235. [PMID: 27909602 DOI: 10.5152/tjar.2016.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Giorgio Della Rocca
- University of Udine, Department of Medical and Biological Sciences, Udine, Italy
| | - Luigi Vetrugno
- University of Udine, Department of Medical and Biological Sciences, Udine, Italy
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13
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Xiao W, Duan QF, Fu WY, Chi XZ, Wang FY, Ma DQ, Wang TL, Zhao L. Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns. Chin Med J (Engl) 2016; 128:1922-31. [PMID: 26168834 PMCID: PMC4717919 DOI: 10.4103/0366-6999.160546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCOrapid system can improve well-being of both HDP parturient and their babies. Methods: Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer's solution (LR), parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume (ΔSV) provided via LiDCOrapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results: The severity of HDP was similar between two groups. The total LR infusion (P < 0.01) and urine output (P < 0.05) were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01). There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05), and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05) than in the GDFT group. Conclusions: Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to stable HDP parturient and their babies.
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Affiliation(s)
| | | | | | | | | | | | - Tian-Long Wang
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
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14
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Karaman Ilić M, Madžarac G, Kogler J, Stančić-Rokotov D, Hodoba N. Intraoperative volume restriction in esophageal cancer surgery: an exploratory randomized clinical trial. Croat Med J 2016; 56:290-6. [PMID: 26088854 PMCID: PMC4500974 DOI: 10.3325/cmj.2015.56.290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim To investigate whether the fluid volume administered during esophageal cancer surgery affects pulmonary gas exchange and tissue perfusion. Methods An exploratory single-center randomized clinical trial was performed. Patients with esophageal cancer who underwent Lewis-Tanner procedure between June 2011 and August 2012 at the Department of Thoracic surgery “Jordanovac”, Zagreb were analyzed. Patients were randomized (1:1) to receive a restrictive volume of intraoperative fluid (≤8 mL/kg/h) or a liberal volume (>8 mL/kg/h). Changes in oxygen partial pressure (Pao2), inspired oxygen fraction (FiO2), creatinine, and lactate were measured during and after surgery. Results Overall 16 patients were randomized and they all were analyzed (restrictive group n = 8, liberal group n = 8). The baseline value Pao2/FiO2 ratio (restrictive) was 345.01 ± 35.31 and the value six hours after extubation was 315.51 ± 32.91; the baseline Pao2/FiO2 ratio (liberal) was 330.11 ± 34.71 and the value six hours after extubation was 307.11 ± 30.31. The baseline creatinine value (restrictive) was 91.91 ± 12.67 and the value six hours after extubation was 100.88 ± 18.33; the baseline creatinine value (liberal) was 90.88 ± 14.99 and the value six hours after extubation was 93.51 ± 16.37. The baseline lactate value (restrictive) was 3.93 ± 1.33 and the value six hours after extubation was 2.69 ± 0.91. The baseline lactate value (liberal) was 3.26 ± 1.25 and the value six hours after extubation was 2.40 ± 1.08. The two groups showed no significant differences in Pao2/FiO2 ratio (P = 0.410), creatinine (P = 0.410), or lactate (P = 0.574). Conclusions Restriction of intraoperative applied volume does not significantly affect pulmonary exchange function or tissue perfusion in patients undergoing surgical treatment for esophageal cancer. Trial registration number: Clinical Trials NCT 02033213.
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Affiliation(s)
- Maja Karaman Ilić
- Maja Karaman Ilić, University Hospital Centre Zagreb, Department of Anesthesiology, Jordanovac 104, 10000 Zagreb, Croatia,
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15
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Holder AL, Clermont G. Using what you get: dynamic physiologic signatures of critical illness. Crit Care Clin 2015; 31:133-64. [PMID: 25435482 DOI: 10.1016/j.ccc.2014.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The development and resolution of cardiopulmonary instability take time to become clinically apparent, and the treatments provided take time to have an impact. The characterization of dynamic changes in hemodynamic and metabolic variables is implicit in physiologic signatures. When primary variables are collected with high enough frequency to derive new variables, this data hierarchy can be used to develop physiologic signatures. The creation of physiologic signatures requires no new information; additional knowledge is extracted from data that already exist. It is possible to create physiologic signatures for each stage in the process of clinical decompensation and recovery to improve outcomes.
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Affiliation(s)
- Andre L Holder
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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16
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Eng OS, Arlow RL, Moore D, Chen C, Langenfeld JE, August DA, Carpizo DR. Fluid administration and morbidity in transhiatal esophagectomy. J Surg Res 2015; 200:91-7. [PMID: 26319974 DOI: 10.1016/j.jss.2015.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/01/2015] [Accepted: 07/09/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Esophagectomy is associated with significant morbidity. Optimizing perioperative fluid administration is one potential strategy to mitigate morbidity. We sought to investigate the relationship of intraoperative fluid (IOF) administration to outcomes in patients undergoing transhiatal esophagectomy with particular attention to malnourished patients, who may be more susceptible to the effects of fluid overload. MATERIAL AND METHODS Patients who underwent transhiatal esophagectomy from 2000-2013 were identified from a retrospective database. IOF rates (mL/kg/hr) were determined and their relationship to outcomes compared. To examine the impact of malnutrition, we stratified patients based on median preoperative serum albumin and compared outcomes. RESULTS AND DISCUSSION 211 patients comprised the cohort. 74% of patients underwent esophagectomy for esophageal adenocarcinoma. Linear regression analyses were performed comparing independent perioperative variables to four outcomes variables: length of stay, complications per patient, major complications, and Clavien-Dindo classification. IOF rate was significantly associated with three of four outcomes on univariate analysis. Significantly more patients with a preoperative albumin level ≤3.7 g/dL who received more than the median IOF rate experienced more severe complications. CONCLUSIONS Increased intraoperative fluid administration is associated with perioperative morbidity in patients undergoing transhiatal esophagectomy. Patients with lower preoperative albumin levels may be particularly sensitive to the effects of volume overload.
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Affiliation(s)
- Oliver S Eng
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903
| | - Renee L Arlow
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903
| | - Dirk Moore
- Department of Biostatistics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Chunxia Chen
- Department of Biostatistics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - John E Langenfeld
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - David A August
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Darren R Carpizo
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08903; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.
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17
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Bartels K, Fiegel M, Stevens Q, Ahlgren B, Weitzel N. Approaches to perioperative care for esophagectomy. J Cardiothorac Vasc Anesth 2014; 29:472-80. [PMID: 25649698 DOI: 10.1053/j.jvca.2014.10.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Karsten Bartels
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Matthew Fiegel
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Quinn Stevens
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Bryan Ahlgren
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Nathaen Weitzel
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
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18
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Benes J, Giglio M, Brienza N, Michard F. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:584. [PMID: 25348900 PMCID: PMC4234857 DOI: 10.1186/s13054-014-0584-z] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 10/09/2014] [Indexed: 12/21/2022]
Abstract
Introduction Dynamic predictors of fluid responsiveness, namely systolic pressure variation, pulse pressure variation, stroke volume variation and pleth variability index have been shown to be useful to identify in advance patients who will respond to a fluid load by a significant increase in stroke volume and cardiac output. As a result, they are increasingly used to guide fluid therapy. Several randomized controlled trials have tested the ability of goal-directed fluid therapy (GDFT) based on dynamic parameters (GDFTdyn) to improve post-surgical outcome. These studies have yielded conflicting results. Therefore, we performed this meta-analysis to investigate whether the use of GDFTdyn is associated with a decrease in post-surgical morbidity. Methods A systematic literature review, using MEDLINE, EMBASE, and The Cochrane Library databases through September 2013 was conducted. Data synthesis was obtained by using odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) by random-effects model. Results In total, 14 studies met the inclusion criteria (961 participants). Post-operative morbidity was reduced by GDFTdyn (OR 0.51; CI 0.34 to 0.75; P <0.001). This effect was related to a significant reduction in infectious (OR 0.45; CI 0.27 to 0.74; P = 0.002), cardiovascular (OR 0.55; CI 0.36 to 0.82; P = 0.004) and abdominal (OR 0.56; CI 0.37 to 0.86; P = 0.008) complications. It was associated with a significant decrease in ICU length of stay (WMD −0.75 days; CI −1.37 to −0.12; P = 0.02). Conclusions In surgical patients, we found that GDFTdyn decreased post-surgical morbidity and ICU length of stay. Because of the heterogeneity of studies analyzed, large prospective clinical trials would be useful to confirm our findings. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0584-z) contains supplementary material, which is available to authorized users.
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19
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Ashes C, Slinger P. Volume Management and Resuscitation in Thoracic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0081-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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20
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Alvis-Miranda HR, Rubiano AM, Puyana JC, Alcala-Cerra G, Moscote-Salazar LR. Fluid therapy in neurotrauma: basic and clinical concepts. REVIEWS IN HEALTH CARE 2014; 5:7-22. [PMID: 36196250 PMCID: PMC9529066 DOI: 10.7175/rhc.v5i1.636] [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] [Indexed: 09/19/2023] Open
Abstract
The patient with head trauma is a challenge for the emergency physician and for the neurosurgeon. Currently traumatic brain injury constitutes a public health problem. Knowledge of the various therapeutic strategies to provide support in the prehospital and perioperative are essential for optimal care. Rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure quickly is now the standard treatment for patients with combined TBI and HS The fluid in patients with brain and especially in the carrier of brain injury is a critical topic; we present a review of the literature about the history, physiology of current fluid preparations, and a discussion regard the use of fluid therapy in traumatic brain injury and decompressive craniectomy.
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Affiliation(s)
| | | | - Juan C. Puyana
- Director of Surgical ICU, director of the Surgical Critical Care Program at the University of Pittsburgh Medical Center at Presbyterian Hospital, Pittsburgh, USA
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21
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Alvis-Miranda HR, Castellar-Leones SM, Moscote-Salazar LR. Intravenous Fluid Therapy in Traumatic Brain Injury and Decompressive Craniectomy. Bull Emerg Trauma 2014; 2:3-14. [PMID: 27162857 PMCID: PMC4771253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 11/15/2013] [Accepted: 11/28/2013] [Indexed: 06/05/2023] Open
Abstract
The patient with head trauma is a challenge for the emergency physician and for the neurosurgeon. Currently traumatic brain injury constitutes a public health problem. Knowledge of the various supportive therapeutic strategies in the pre-hospital and pre-operative stages is essential for optimal care. The immediate rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure is now the standard treatment of patients with combined traumatic brain injury (TBI) and hemorrhagic shock (HS). The fluid in patients with brain trauma and especially in patients with brain injur y is a critical issue. In this context we present a review of the literature about the history, physiology of current fluid preparations, and a discussion regarding the use of fluid therapy in traumatic brain injury and decompressive craniectomy.
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22
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Zhang J, Chen CQ, Lei XZ, Feng ZY, Zhu SM. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study. Clinics (Sao Paulo) 2013; 68:1065-70. [PMID: 23917675 PMCID: PMC3715019 DOI: 10.6061/clinics/2013(07)27] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/02/2013] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. METHODS Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. RESULTS The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. CONCLUSION The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting) in thoracic surgery patients requiring one-lung ventilation.
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Affiliation(s)
- Jian Zhang
- Department of Anesthesiology, First Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou, Zhejiang/China
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23
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Abstract
Better understanding of the pathophysiology of acute lung injury (ALI) and the hazards inherent to extremes in volume status has led efforts toward goal-directed, individualized therapies designed to achieve optimal hemodynamic status. The role for colloids both as a volume expander and potential protective agent against ALI is receiving revived interest. The evidence for the impact of fluid therapy is encouraging and supports the undertaking of properly designed perioperative fluid trials in thoracic surgeries. Such work offers hope that optimal fluid strategies can be defined and reduce the adverse events that have affected patients having lung resection.
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Affiliation(s)
- Cait P Searl
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
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