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Li J, Stadlbauer A, Heller A, Song Z, Petermichl W, Foltan M, Schmid C, Schopka S. Impact of fluid balance and blood transfusion during extracorporeal circulation on outcome for acute type A aortic dissection surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:734-741. [PMID: 35913035 DOI: 10.23736/s0021-9509.22.12339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND In thoracic aortic surgery, fluid replacement and blood transfusion during extracorporeal circulation (ECC) are associated with increased coagulopathy, elevated inflammatory response, and end-organ dysfunction. The optimal strategy has not been established in this regard. The aim of this study was to evaluate the effect of the fluid balance during ECC in thoracic aortic dissection surgery on outcome. METHODS Between 2009 and 2020, 358 patients suffering from acute type A aortic dissection (ATAAD) underwent aortic surgery at our heart center. In-hospital mortality, major complications (postoperative stroke, respiratory failure, heart failure, acute renal failure), and follow-up mortality were assessed. Logistic regression analysis was used to identify whether fluid balance and blood transfusion during ECC were risk factors for occurring adverse events. RESULTS The in-hospital mortality amounted to 20.4%. Major complications included temporary neurologic deficit in 13.4%, permanent neurologic deficit in 6.1%, acute renal failure in 32.7%, prolonged ventilation for respiratory failure in 17.9%, and acute heart failure in 10.9% of cases. At a mean of 42 months after discharge of 285 survivors, follow-up mortality was 13.3%. Multivariate analysis revealed major complications as well as the risk of in-hospital and follow-up mortality to increase with fluid balance and blood transfusion during ECC. CONCLUSIONS Fluid balance and blood transfusion during ECC present with predictive potential concerning the risk of postoperative adverse events.
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Affiliation(s)
- Jing Li
- Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany -
| | - Andrea Stadlbauer
- Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
| | - Anton Heller
- Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
| | - Zhiyang Song
- Institute of Mathematics, Ludwig-Maximilian University Munich, Munich, Germany
| | - Walter Petermichl
- Department of Anesthesiology, University Medical Center of Regensburg, Regensburg, Germany
| | - Maik Foltan
- Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
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Arumugam R, Thomas S, Jacob NSM, Nadaraj A, George SP, Singh G. Relationship between pulse pressure variation and stroke volume variation with changes in cardiac index during hypotension in patients undergoing major spine surgeries in prone position - A prospective observational study. J Anaesthesiol Clin Pharmacol 2022; 38:553-559. [PMID: 36778833 PMCID: PMC9912902 DOI: 10.4103/joacp.joacp_594_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/04/2021] [Accepted: 07/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Aims Dynamic indices such as pulse pressure variation (PPV) and stroke volume variation (SVV) are better predictors of fluid responsiveness than static indices. There is a strong correlation between PPV and SVV in the prone position when assessed with the fluid challenge. However, this correlation has not been established during intraoperative hypotension. Our study aimed to assess the correlation between PPV and SVV during hypotension in the prone position and its relationship with cardiac index (CI). Material and Methods Thirty patients aged 18-70 years of ASA class I-III, undergoing spine procedures in the prone position were recruited for this prospective observational study. Hemodynamic variables such as heart rate (HR), mean arterial pressure (MAP), PPV, SVV, and CI were measured at baseline (after induction of anesthesia and positioning in the prone position). This set of variables were collected at the time of hypotension (T-before) and after correction (T-after) with either fluids or vasopressors. HR and MAP are presented as median with inter quartile range and compared by Mann-Whitney U test. Reliability was measured by intraclass correlation coefficients (ICC). Generalized estimating equations were performed to assess the change of CI with changes in PPV and SVV. Results A statistically significant linear relationship between PPV and SVV was observed. The ICC between change in PPV and SVV during hypotension was 0.9143, and after the intervention was 0.9091 (P < 0.001). Regression of changes in PPV and SVV on changes in CI depicted the reciprocal change in CI which was not statistically significant. Conclusion PPV is a reliable surrogate of SVV during intraoperative hypotension in the prone position.
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Affiliation(s)
- Rajasekar Arumugam
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Manchester University Hospital NHS Foundation Trust, United Kingdom
| | - Susan Thomas
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nisha Sara M Jacob
- Department of Anaesthesia, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sajan P. George
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Georgene Singh
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
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Restrictive intraoperative fluid management was associated with higher incidence of composite complications compared to less restrictive strategies in open thoracotomy: A retrospective cohort study. Sci Rep 2020; 10:8449. [PMID: 32439944 PMCID: PMC7242459 DOI: 10.1038/s41598-020-65532-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/30/2020] [Indexed: 01/15/2023] Open
Abstract
Restrictive fluid management has been recommended for thoracic surgery. However, specific guidelines are lacking, and there is always concern regarding impairment of renal perfusion with a restrictive policy. The objective of this study was to find the net intraoperative fluid infusion rate which shows the lowest incidence of composite complications (either pulmonary complications or acute kidney injury) in open thoracotomy. We hypothesized that a certain range of infusion rate would decrease the composite complications within postoperative 30 days. All patients (n = 1,031) who underwent open thoracotomy at a tertiary care university hospital were included in this retrospective study. The time frame of fluid monitoring was from the start of operation to postoperative 24 hours. The cutoff value of the intraoperative net fluid amount was 4–5 ml.kg−1.h−1 according to the minimum p-value method, thus, patients were divided into Low (≤3 ml.kg−1.h−1), Cutoff (4–5 ml.kg−1.h−1) and High (≥6 ml.kg−1.h−1) groups. The Cutoff group showed the lowest composite complication rate (19%, 12%, and 13% in the Low, Cutoff, and High groups, respectively, P = 0.0283; Low vs. Cutoff, P = 0.0324, Bonferroni correction). Acute respiratory distress syndrome occurred least frequently in the Cutoff group (7%, 3%, and 6% for the Low, Cutoff, and High groups, respectively, P = 0.0467; Low vs. Cutoff, P = 0.0432, Bonferroni correction). In multivariable analysis, intraoperative net fluid infusion rate was associated with composite complications, and the Cutoff group decreased risk (odds ratio 0.54, 95% confidence interval: 0.35–0.81, P = 0.0035). In conclusion, maintaining intraoperative net fluid infusion at 4–5 ml.kg−1.h−1 was associated with better results in open thoracotomy, in terms of composite complications, compared to more restrictive fluid management.
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Araos J, Kenny JES, Rousseau-Blass F, Pang DS. Dynamic prediction of fluid responsiveness during positive pressure ventilation: a review of the physiology underlying heart-lung interactions and a critical interpretation. Vet Anaesth Analg 2019; 47:3-14. [PMID: 31831334 DOI: 10.1016/j.vaa.2019.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 07/10/2019] [Accepted: 08/17/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cardiovascular responses to hypovolemia and hypotension are depressed during general anesthesia. A considerable number of anesthetized and critically ill animals may not benefit hemodynamically from a fluid bolus; therefore, it is important to have measures for accurate prediction of fluid responsiveness. Static measures of preload, such as central venous pressure, do not provide accurate prediction of fluid responsiveness, whereas dynamic measures of cardiovascular function, obtained during positive pressure ventilation, are highly predictive. This review describes key physiological concepts behind heart-lung interactions during positive pressure ventilation, factors that can modify this relationship and provides the basis for a rational interpretation of the information obtained from dynamic measurements, with a focus on pulse pressure variation (PPV). DATABASE USED PubMed. Search items used were: heart-lung interaction, positive pressure ventilation, pulse pressure variation, dynamic index of fluid therapy, goal-directed hemodynamic therapy, dogs, cats, pigs, horses and rabbits. CONCLUSIONS The veterinary literature suggests that targeting specific PPV thresholds should guide fluid therapy in lieu of conventional assessments. Understanding the physiology of heart-lung interactions during intermittent positive pressure ventilation provides a rational basis for interpreting the literature on dynamic indices of fluid responsiveness, including PPV. Clinical trials are needed to evaluate whether goal-directed fluid therapy based on PPV results in improved outcomes in veterinary patient populations.
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Affiliation(s)
- Joaquin Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
| | | | - Frederik Rousseau-Blass
- Centre Hospitalier Universitaire Veterinaire, Faculte de Medecine Veterinaire, Universite de Montreal, Saint-Hyacinthe, QC, Canada
| | - Daniel Sj Pang
- Centre Hospitalier Universitaire Veterinaire, Faculte de Medecine Veterinaire, Universite de Montreal, Saint-Hyacinthe, QC, Canada; Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, AB, Canada
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Kovarnik T, Navratil M, Belohlavek J, Mlcek M, Chval M, Chen Z, Jerabek S, Kittnar O, Linhart A. Validation of new marker of fluid responsiveness based on Doppler assessment of blood flow velocity in superior vena cava in mechanically ventilated pigs. Intensive Care Med Exp 2018; 6:36. [PMID: 30251225 PMCID: PMC6153205 DOI: 10.1186/s40635-018-0199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We studied a novel approach for the evaluation and management of volemia: minimally invasive monitoring of respiratory blood flow variations in the superior vena cava (SVC). We performed an experiment with 10 crossbred (Landrace × large white) female pigs (Sus scrofa domestica). METHODS Hypovolemia was induced by bleeding from a femoral artery, in six stages. This was followed by blood return and then an infusion of 1000 ml saline, resulting in hypervolemia. Flow in the SVC was measured by Flowire (Volcano corp., USA), located in a distal channel of a triple-lumen central venous catheter. The key parameters measured were venous return variation index (VRV)-a new index for fluid responsiveness, calculated from the maximal and minimal velocity time intervals during controlled ventilation-and systolic peak velocity (defined as peak velocity of a systolic wave using the final end-expiratory beat). A Swan-Ganz catheter (Edwards Lifesciences, USA) was introduced into the pulmonary artery to measure pulmonary arterial pressure, pulmonary capillary wedge pressure, and continuous cardiac output measurements, using the Vigilance monitor (Edwards Lifesciences, USA). RESULTS We analyzed 44 VRV index measurements during defined hemodynamic status events. The curves of VRV indexes for volume responders and volume non-responders intersected at a VRV value of 27, with 10% false negativity and 2% false positivity. We compared the accuracy of VRV and pulse pressure variations (PPV) for separation of fluid responders and fluid non-responders using receiver operating characteristic (ROC) curves. VRV was better (AUCROC 0.96) than PPV (AUCROC 0.85) for identification of fluid responders. The VRV index exhibited the highest relative change during both hypovolemia and hypervolemia, compared to standard hemodynamic measurement. CONCLUSIONS The VRV index provides a real-time method for continuous assessment of fluid responsiveness. It combines the advantages of echocardiography-based methods with a direct and continuous assessment of right ventricular filling during mechanical ventilation.
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Affiliation(s)
- Tomas Kovarnik
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic. .,II. interni klinika VFN a 1.LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic.
| | - Miroslav Navratil
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Mikulas Mlcek
- Department of Physiology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Martin Chval
- Institute for Research and Development of Education, Faculty of Education, Charles University in Prague, Prague, Czech Republic
| | - Zhi Chen
- Department of Electrical and Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Stepan Jerabek
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Otomar Kittnar
- Department of Physiology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Fantoni DT, Ida KK, Gimenes AM, Mantovani MM, Castro JR, Patrício GCF, Ambrósio AM, Otsuki DA. Pulse pressure variation as a guide for volume expansion in dogs undergoing orthopedic surgery. Vet Anaesth Analg 2017; 44:710-718. [PMID: 28734854 DOI: 10.1016/j.vaa.2016.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/14/2016] [Accepted: 11/20/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate whether pulse pressure variation (PPV) can predict fluid responsiveness in healthy dogs during clinical surgery. STUDY DESIGN Prospective clinical study. ANIMALS Thirty-three isoflurane-anesthetized dogs with arterial hypotension during orthopedic surgery. METHODS Fluid challenge with lactated Ringer's solution (15 mL kg-1 in 15 minutes) was administered in mechanically ventilated dogs (tidal volume 10 mL kg-1) with hypotension [mean arterial pressure (MAP) < 65 mmHg]. The volume expansion was considered effective if cardiac output (CO; transesophageal Doppler) increased by ≥ 15%. Cardiopulmonary data were analyzed using two-way ANOVA, receiver operating characteristics (ROC) curves and Spearman coefficient; p < 0.05 was considered significant. RESULTS Effective volume expansion, mean ± standard deviation 42 ± 4% increase in CO (p < 0.0001) was observed in 76% of the dogs, resulting in a decrease in PPV (p < 0.0001) and increase in MAP (p < 0.0001), central venous pressure (CVP; p = 0.02) and ejection fraction (p < 0.0001) compared with before the fluid challenge. None of these changes occurred when volume expansion resulted in a nonsignificant CO increase of 4 ± 5%. No significant differences were observed in blood gas analysis between responsive and nonresponsive dogs. The increase in CO was correlated with the decrease in PPV (r = -0.65; p < 0.0001) but absolute values of CO and PPV were not correlated. The PPV performance (ROC curve area: 0.89 ± 0.06, p = 0.0011) was better than that of CVP (ROC curve area: 0.54 ± 0.12) and MAP (ROC curve area: 0.59 ± 0.13) to predict fluid responsiveness. The best cut-off for PPV to distinguish responders and nonresponders was 15% (50% sensitivity and 96% specificity). CONCLUSIONS AND CLINICAL RELEVANCE In mechanically ventilated, healthy, isoflurane-anesthetized dogs, PPV predicted fluid responsiveness to volume expansion, and MAP and CVP did not show such applicability.
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Affiliation(s)
- Denise T Fantoni
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation 8, Anesthesiology, Medical School, University of São Paulo, São Paulo, Brazil
| | - Keila K Ida
- Laboratory of Medical Investigation 8, Anesthesiology, Medical School, University of São Paulo, São Paulo, Brazil.
| | - André M Gimenes
- Department of Internal Medicine, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Matheus M Mantovani
- Department of Internal Medicine, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Jacqueline R Castro
- Department of Internal Medicine, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Geni C F Patrício
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Aline M Ambrósio
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Denise A Otsuki
- Laboratory of Medical Investigation 8, Anesthesiology, Medical School, University of São Paulo, São Paulo, Brazil
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Tusman G, Bohm SH, Suarez-Sipmann F. Advanced Uses of Pulse Oximetry for Monitoring Mechanically Ventilated Patients. Anesth Analg 2017; 124:62-71. [DOI: 10.1213/ane.0000000000001283] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Oshiro AH, Otsuki DA, Hamaji MWM, Rosa KT, Ida KK, Fantoni DT, Auler JOC. Pulse pressure variation and stroke volume variation under different inhaled concentrations of isoflurane, sevoflurane and desflurane in pigs undergoing hemorrhage. Clinics (Sao Paulo) 2015; 70:804-9. [PMID: 26735220 PMCID: PMC4676316 DOI: 10.6061/clinics/2015(12)07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Inhalant anesthesia induces dose-dependent cardiovascular depression, but whether fluid responsiveness is differentially influenced by the inhalant agent and plasma volemia remains unknown. The aim of this study was to compare the effects of isoflurane, sevoflurane and desflurane on pulse pressure variation and stroke volume variation in pigs undergoing hemorrhage. METHODS Twenty-five pigs were randomly anesthetized with isoflurane, sevoflurane or desflurane. Hemodynamic and echocardiographic data were registered sequentially at minimum alveolar concentrations of 1.00 (M1), 1.25 (M2), and 1.00 (M3). Then, following withdrawal of 30% of the estimated blood volume, these data were registered at a minimum alveolar concentrations of 1.00 (M4) and 1.25 (M5). RESULTS The minimum alveolar concentration increase from 1.00 to 1.25 (M2) decreased the cardiac index and increased the central venous pressure, but only modest changes in mean arterial pressure, pulse pressure variation and stroke volume variation were observed in all groups from M1 to M2. A significant decrease in mean arterial pressure was only observed with desflurane. Following blood loss (M4), pulse pressure variation, stroke volume variation and central venous pressure increased (p < 0.001) and mean arterial pressure decreased in all groups. Under hypovolemia, the cardiac index decreased with the increase of anesthesia depth in a similar manner in all groups. CONCLUSION The effects of desflurane, sevoflurane and isoflurane on pulse pressure variation and stroke volume variation were not different during normovolemia or hypovolemia.
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Affiliation(s)
- Alexandre Hideaki Oshiro
- Faculdade de Medicina da Universidade de São Paulo, Programa de Pós-Graduação em Anestesiologia, São Paulo/SP, Brazil
| | - Denise Aya Otsuki
- Faculdade de Medicina da Universidade de São Paulo, Programa de Pós-Graduação em Anestesiologia, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Investigação Médica (LIM-08/ Anestesiologia), São Paulo/SP, Brazil
- Corresponding author: E-mail:
| | - Marcelo Waldir M Hamaji
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Investigação Médica (LIM-08/ Anestesiologia), São Paulo/SP, Brazil
| | - Kaleizu T Rosa
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Investigação Médica (LIM-08/ Anestesiologia), São Paulo/SP, Brazil
| | - Keila Kazue Ida
- Faculdade de Medicina da Universidade de São Paulo, Programa de Pós-Graduação em Anestesiologia, São Paulo/SP, Brazil
| | - Denise T Fantoni
- Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, Departamento de Cirurgia, São Paulo/SP, Brazil
| | - José Otavio Costa Auler
- Faculdade de Medicina da Universidade de São Paulo, Programa de Pós-Graduação em Anestesiologia, São Paulo/SP, Brazil
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Zhang J, Qiao H, He Z, Wang Y, Che X, Liang W. Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive. Clinics (Sao Paulo) 2012; 67:1149-55. [PMID: 23070341 PMCID: PMC3460017 DOI: 10.6061/clinics/2012(10)06] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 05/28/2012] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective, randomized study with lactated Ringer's solution and 6% hydroxyethyl starch solution. METHOD A total of 60 patients who were undergoing gastrointestinal surgery were randomized into a restrictive lactated Ringer's group (n = 20), a goal-directed lactated Ringer's group (n = 20) and a goal-directed hydroxyethyl starch group (n = 20). The goal-directed fluid treatment was guided by pulse pressure variation, which was recorded during surgery using a simple manual method with a Datex Ohmeda S/5 Monitor and minimized to 11% or less by volume loading with either lactated Ringer's solution or 6% hydroxyethyl starch solution (130/0.4). The postoperative flatus time, the length of hospital stay and the incidence of complications were recorded as endpoints. RESULTS The goal-directed lactated Ringer's group received the greatest amount of total operative fluid compared with the two other groups. The flatus time and the length of hospital stay in the goal-directed hydroxyethyl starch group were shorter than those in the goal-directed lactated Ringer's group and the restrictive lactated Ringer's group. No significant differences were found in the postoperative complications among the three groups. CONCLUSION Monitoring and minimizing pulse pressure variation by 6% hydroxyethyl starch solution (130/0.4) loading during gastrointestinal surgery improves postoperative outcomes and decreases the discharge time of patients who are graded American Society of Anesthesiologists physical status I/II.
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Affiliation(s)
- Jun Zhang
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
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Patel KK, Caramelli B, Silva MRE. Original research articles on the cardiopulmonary system recently appeared in Brazilian clinical and surgical journals. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000600022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Original research articles on the cardiopulmonary system recently appeared in Brazilian clinical and surgical journals. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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