1
|
Choo CL, Law LS, How WJ, Goh BY, Ashokka B. A systematic review and meta-analysis on the effect of goal-directed fluid therapy on postoperative outcomes in renal transplantation surgeries. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:679-694. [PMID: 38920161 DOI: 10.47102/annals-acadmedsg.202367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction This systematic review and meta-analysis investigated the impact of intraoperative goal-directed therapy (GDT) compared with conventional fluid therapy on postoperative outcomes in renal transplantation recipients, addressing this gap in current literature. Method A systematic search of patients aged ≥18 years who have undergone single-organ primary renal transplantations up to June 2022 in PubMed, Embase, Scopus and CINAHL Plus was performed. Primary outcome examined was postoperative renal function. Secondary outcomes assessed were mean arterial pressure at graft reperfusion, intraoperative fluid volume and other postoperative complications. Heterogeneity was tested using I² test. The study protocol was registered on PROSPERO. Results A total of 2459 studies were identified. Seven eligible studies on 607 patients were included. Subgroup assessments revealed potential renal protective benefits of GDT, with patients receiving cadaveric grafts showing lower serum creatinine on postoperative days 1 and 3, and patients monitored with arterial waveform analysis devices experiencing lower incidences of postoperative haemodialysis. Overall analysis found GDT resulted in lower incidence of tissue oedema (risk ratio [RR] 0.34, 95% CI 0.15-0.78, P=0.01) and respiratory complications (RR 0.39, 95% CI 0.17-0.90, P=0.03). However, quality of data was deemed low given inclusion of non-randomised studies, presence of heterogeneities and inconsistencies in defining outcomes measures. Conclusion While no definitive conclusions can be ascertained given current limitations, this review highlights potential benefits of using GDT in renal transplantation recipients. It prompts the need for further standardised studies to address limitations discussed in this review.
Collapse
Affiliation(s)
- Caitlin Lmc Choo
- Department of Anaesthesia, National University Hospital, Singapore
| | - Lawrence Sc Law
- Department of Medicine, National University Hospital, Singapore
| | - Wen Jie How
- Department of Anaesthesia, National University Hospital, Singapore
| | - Benjamin Ys Goh
- National University Centre for Organ Transplantation, National University Hospital, Singapore
| | | |
Collapse
|
2
|
Soriano Hervás M, Robles-Hernández D, Serra A, Játiva-Porcar R, Gómez Quiles L, Maiocchi K, Llorca S, Climent MT, Llueca A. Analysis of Intraoperative Variables Responsible for the Increase in Lactic Acid in Patients Undergoing Debulking Surgery. J Pers Med 2023; 13:1540. [PMID: 38003855 PMCID: PMC10672096 DOI: 10.3390/jpm13111540] [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: 09/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Background: Cytoreductive surgery (CRS) is a complex procedure with a high incidence of perioperative complications. Elevated lactacidaemia levels have been associated with complications and perioperative morbidity and mortality. This study aims to analyse the intraoperative variables of patients undergoing CRS and their relationship with lactacidaemia levels. Methods: This retrospective, observational study included 51 patients with peritoneal carcinomatosis who underwent CRS between 2014 and 2016 at the Abdomino-Pelvic Oncological Surgery Reference Unit (URCOAP) of the General University Hospital of Castellón (HGUCS). The main variable of interest was the level of lactic acid at the end of surgery. Intraoperative variables, including preoperative haemoglobin, duration of surgery, intraoperative bleeding, fluid therapy administered, administration of blood products, and intraoperative peritoneal cancer index (PCI), were analysed. Results: Positive correlations were found between lactic acid levels and PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products. Additionally, a negative correlation was observed between haemoglobin levels and lactic acid levels. Notably, the strongest correlations were found with operative PCI (ρ = 0.532; p-value < 0.001) and duration of surgery (ρ = 0.518; p-value < 0.001). Conclusions: PCI and duration of surgery are decisive variables in determining the prognosis of patients undergoing debulking surgery. This study suggests that, for each minute of surgery, lactic acid levels increase by 0.005 mmol/L, and for each unit increase in PCI, lactic acid levels increase by 0.060 mmol/L.
Collapse
Affiliation(s)
- Marta Soriano Hervás
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Daniel Robles-Hernández
- Department of Anaesthesiology, University La Plana Hospital, Road from Vila-Real to Burriana, km 0.5, 12540 Castellón, Spain
| | - Anna Serra
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Rosa Játiva-Porcar
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Luis Gómez Quiles
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Karina Maiocchi
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - María Teresa Climent
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Antoni Llueca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| |
Collapse
|
3
|
Field RR, Mai T, Hanna S, Harrington B, Calderon MD, Rinehart J. Lack of impact of nil-per-os (NPO) time on goal-directed fluid delivery in first case versus afternoon case starts: a retrospective cohort study. BMC Anesthesiol 2019; 19:191. [PMID: 31656163 PMCID: PMC6815464 DOI: 10.1186/s12871-019-0864-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/30/2019] [Indexed: 02/04/2023] Open
Abstract
Background Goal Directed Fluid Therapy (GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr., and total ml/kg/hr. between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr., or ml/kg/hr., the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p = 0.64 and p = 0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.
Collapse
Affiliation(s)
- R Ryan Field
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA.
| | - Tuan Mai
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | | | - Brian Harrington
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Michael-David Calderon
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| |
Collapse
|
4
|
Yin K, Ding J, Wu Y, Peng M. Goal-directed fluid therapy based on noninvasive cardiac output monitor reduces postoperative complications in elderly patients after gastrointestinal surgery: A randomized controlled trial. Pak J Med Sci 2018; 34:1320-1325. [PMID: 30559778 PMCID: PMC6290223 DOI: 10.12669/pjms.346.15854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective: Goal-directed fluid therapy (GDFT) was associated with improved outcomes after surgery. Noninvasive Cardiac Output Monitoring (NICOM) has proved to be a good choice for guiding GDFT. This study evaluated the effect of GDFT based on NICOM on prognosis in elderly patients undergoing resection of gastrointestinal tumor. Methods: Fifty patients scheduled for elective laparoscopic radical resection for stomach, colon or rectal cancer in Yongchuan Hospital of Chongqing Medical University between November 2014 and December 2015 were included and randomly divided into two groups: conventional fluid therapy (group C, n=25) and goal-directed fluid therapy (group G, n=25). The primary outcome was moderate or severe postoperative complications within 30 days. Results: Finally, 45 patients successfully completed the study (group G, n=22; group C, n=23). There were no difference of the duration of surgery, the requirement of vasoactive agents and the bleeding volume between two groups (P>0.05). Total fluids infused were 2956±629 ml (group C) and 2259±454 ml (group G) (P<0.05), while the requirement of colloid was increased in group G (1103±285ml vs 855±226ml) (P<0.05). The MAP and the mean CI were higher in group G (P<0.05). Compared with group C, the time when the patients passed the flatus and the length of hospital stay after operation were shortened in group G (12.6±2.4day vs17.2±2.6day), the incidence of postoperative complications were significantly lower in group G (P<0.05). Conclusions: Goal-directed fluid therapy based on NICOM was significantly associated with improvement of prognosis in elderly patients undergoing resection of gastrointestinal tumor which reduced postoperative complications.
Collapse
Affiliation(s)
- Kaiyu Yin
- Kaiyu Yin, Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Jiahui Ding
- Jiahui Ding, Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - You Wu
- You Wu, Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Mingqing Peng
- Mingqing Peng, Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| |
Collapse
|
5
|
Umari M, Falini S, Segat M, Zuliani M, Crisman M, Comuzzi L, Pagos F, Lovadina S, Lucangelo U. Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice. J Thorac Dis 2018; 10:S542-S554. [PMID: 29629201 PMCID: PMC5880994 DOI: 10.21037/jtd.2017.12.83] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/11/2017] [Indexed: 12/18/2022]
Abstract
In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine.
Collapse
Affiliation(s)
- Marzia Umari
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Stefano Falini
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Matteo Segat
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Michele Zuliani
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Marco Crisman
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Lucia Comuzzi
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Francesco Pagos
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Stefano Lovadina
- Department of General and Thoracic Surgery, Cattinara University Hospital, Trieste, Italy
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| |
Collapse
|
6
|
Postoperative Visceral Tissue Edema Assessed by Computed Tomography Is a Predictor for Severe Complications After Pancreaticoduodenectomy. J Gastrointest Surg 2018; 22:77-87. [PMID: 29047069 DOI: 10.1007/s11605-017-3608-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/03/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIMS In pancreatoduodenectomy (PD), the adverse impact of tissue edema owing to intraoperative fluid overload remains unclear. This study aims to evaluate how visceral tissue edema due to fluid overload affects severe postoperative complications after PD. It aims to clarify the usefulness of assessment by computed tomography (CT) of postoperative tissue edema. METHODS We classified 200 patients who underwent PD as either liberal fluid management (LFM) group (n = 100) or goal-directed fluid therapy (GDFT) group (n = 100), based on intraoperative fluid management. We assessed postoperative tissue edema by cross section of the body trunk area using pre- and postoperative CT. RESULTS Severe complication (Clavien-Dindo more than grade III) rate was significantly higher in LFM group than GDFT group (37 vs. 17%, P = 0.001). Independent risk factors of severe complications after PD included diameter of main pancreatic duct ≤ 3 mm at the cut surface (P = 0.041; OR 2.274; 95% CI 1.034-5.001), LFM (P = 0.005; OR 2.720; 95% CI 1.355-5.462), and increased rate of body trunk area ≥ 20% (P < 0.001; OR 3.448; 95% CI 1.723-5.462). In subgroup analysis of patients with no transfusion, LFM and increased rate of body trunk area ≥ 20% were independent risk factors of severe postoperative complications. CONCLUSIONS Visceral tissue edema evaluation is a valuable method to predict severe complications after PD.
Collapse
|
7
|
Kanda H, Hirasaki Y, Iida T, Kanao-Kanda M, Toyama Y, Kunisawa T, Iwasaki H. Effect of fluid loading on left ventricular volume and stroke volume variability in patients with end-stage renal disease: a pilot study. Ther Clin Risk Manag 2015; 11:1619-25. [PMID: 26527879 PMCID: PMC4621225 DOI: 10.2147/tcrm.s91296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose The aim of this study was to investigate fluid loading-induced changes in left ventricular end-diastolic volume (LVEDV) and stroke volume variability (SVV) in patients with end-stage renal disease (ESRD) using real-time three-dimensional transesophageal echocardiography and the Vigileo-FloTrac system. Patients and methods After obtaining ethics committee approval and informed consent, 28 patients undergoing peripheral vascular procedures were studied. Fourteen patients with ESRD on hemodialysis (HD) were assigned to the HD group and 14 patients without ESRD were assigned to the control group. Institutional standardized general anesthesia was provided in both groups. SVV was measured using the Vigileo-FloTrac system. Simultaneously, a full-volume three-dimensional transesophageal echocardiography dataset was acquired to measure LVEDV, left ventricular end-systolic volume, and left ventricular ejection fraction. Measurements were obtained before and after loading 500 mL hydroxyethyl starch over 30 minutes in both groups. Results In the control group, intravenous colloid infusion was associated with a significant decrease in SVV (13.8%±2.6% to 6.5%±2.6%, P<0.001) and a significant increase in LVEDV (83.6±23.4 mL to 96.1±28.8 mL, P<0.001). While SVV significantly decreased after infusion in the HD group (16.2%±6.0% to 6.2%±2.8%, P<0.001), there was no significant change in LVEDV. Conclusion Our preliminary data suggest that fluid responsiveness can be assessed not by LVEDV but also by SVV due to underlying cardiovascular pathophysiology in patients with ESRD.
Collapse
Affiliation(s)
- Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuji Hirasaki
- Department of Anatomy, The Jikei University Graduate School of Medicine, Minato-ku, Tokyo, Japan
| | - Takafumi Iida
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Megumi Kanao-Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuki Toyama
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroshi Iwasaki
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| |
Collapse
|
8
|
Chen Z, Cao L, Wen Z, Cui N, Li N, Xie J, Tan Z, Luo Z, Wang S, Qin Y, Chen X, Xu Z, Ou A, Shang W, Jiang Z, Chen Q. Study of Evodia hot compress plus electro-acupuncture in patients who have undergone abdominal surgery. Int J Clin Exp Med 2015; 8:16167-16174. [PMID: 26629130 PMCID: PMC4659019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/10/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The importance of postoperative gastrointestinal function recovery is being increasingly recognized. In this multi-center randomized controlled study, we evaluated the efficacy and safety of Evodia hot compress (ECS) plus electro-acupuncture (EA) for patients who developed postoperative gastrointestinal tract dysfunction after abdominal surgery. METHODS 1009 patients who developed postoperative gastrointestinal tract dysfunction after abdominal surgery were enrolled. All patients received conventional therapies for 7 days from the 1st postoperative day and were randomly assigned to receive coarse salt hot compress, Evodia hot compress or Evodia hot compress plus electro-acupuncture twice a day for 7 days. RESULTS The mean time to first flatus and to first bowel sounds was comparable among the four groups (P>0.05). The control group had a significantly shorter time to defecation compared with patients receiving coarse salt hot compress, Evodia hot compress or Evodia hot compress plus electro-acupuncture (P<0.05). In patients undergoing open hepatectomy, the time to first defecation was the shortest in those who received Evodia hot compress plus electro-acupuncture (89.3±25.5 h), which was significantly different from that of controls(134±31.1 h), those who received coarse salt hot compress (106.7±36.4 h) and those who received Evodia hot compress (109.9±42.1 h) (P<0.05) in patients undergoingopen cholecystectomy, the time to first defecation was the shortest in those who received Evodia hot compress (73.1± 24.7), which was significantly different from that of controls (77.8±29.7), those who received coarse salt hot compress 90.5±30.2) and those who received Evodia hot compress plus electro-acupunctur (83.9±34.0). CONCLUSION Evodia hot compress plus electro-acupuncture confers benefit in postoperative recovery of gastrointestinal function of patients who have undergone abdominal surgery and it is overall safe to use. TRIAL REGISTRATION Chinese Clinical Trial RegistryChiCTR-TRC-09000527.
Collapse
Affiliation(s)
- Zhiqiang Chen
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Lixing Cao
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Zehuai Wen
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Naiqiang Cui
- Department of General Surgery, Nankai HospitalTianjin 300100, China
| | - Naiqing Li
- Department of General Surgery, The First Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Jianxing Xie
- Department of General Surgery, Dongzhimen Hospital of Beijing University of Chinese MedicineBeijing 100700, China
| | - Zhijian Tan
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Zhenbin Luo
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Shusheng Wang
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - You Qin
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Xiuhua Chen
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Zhenhua Xu
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Aihua Ou
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Wenfan Shang
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Zhi Jiang
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| | - Qicheng Chen
- Department of Gastrointestinal and Hepatobiliary Surgery, The Second Clinical Teaching Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120, China
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Phan K, An VVG, Ha H, Phan S, Lam V, Pleass H. Hepatic resection for malignant liver tumours in the elderly: a systematic review and meta-analysis. ANZ J Surg 2015; 85:815-22. [DOI: 10.1111/ans.13211] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Kevin Phan
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Department of Surgery; Westmead Hospital; Sydney New South Wales Australia
- St Vincent's Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - Vincent Vinh Gia An
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Department of Surgery; Westmead Hospital; Sydney New South Wales Australia
| | - Hakeem Ha
- St Vincent's Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - Steven Phan
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Vincent Lam
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Department of Surgery; Westmead Hospital; Sydney New South Wales Australia
| | - Henry Pleass
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Department of Surgery; Westmead Hospital; Sydney New South Wales Australia
| |
Collapse
|
11
|
Reliability of a new 4th generation FloTrac algorithm to track cardiac output changes in patients receiving phenylephrine. J Clin Monit Comput 2014; 29:467-73. [PMID: 25267438 DOI: 10.1007/s10877-014-9624-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
Phenylephrine is often used to treat intra-operative hypotension. Previous studies have shown that the FloTrac cardiac monitor may overestimate cardiac output (CO) changes following phenylephrine administration. A new algorithm (4th generation) has been developed to improve performance in this setting. We performed a prospective observational study to assess the effects of phenylephrine administration on CO values measured by the 3rd and 4th generation FloTrac algorithms. 54 patients were enrolled in this study. We used the Nexfin, a pulse contour method shown to be insensitive to vasopressor administration, as the reference method. Radial arterial pressures were recorded continuously in patients undergoing surgery. Phenylephrine administration times were documented. Arterial pressure recordings were subsequently analyzed offline using three different pulse contour analysis algorithms: FloTrac 3rd generation (G3), FloTrac 4th generation (G4), and Nexfin (nf). One minute of hemodynamic measurements was analyzed immediately before phenylephrine administration and then repeated when the mean arterial pressure peaked. A total of 157 (4.6 ± 3.2 per patient, range 1-15) paired sets of hemodynamic recordings were analyzed. Phenylephrine induced a significant increase in stroke volume (SV) and CO with the FloTrac G3, but not with FloTrac G4 or Nexfin algorithms. Agreement between FloTrac G3 and Nexfin was: 0.23 ± 1.19 l/min and concordance was 51.1%. In contrast, agreement between FloTrac G4 and Nexfin was: 0.19 ± 0.86 l/min and concordance was 87.2%. In conclusion, the pulse contour method of measuring CO, as implemented in FloTrac 4th generation algorithm, has significantly improved its ability to track the changes in CO induced by phenylephrine.
Collapse
|
12
|
Shin D. Perioperative nutritional therapy for surgical patients. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2014. [DOI: 10.5124/jkma.2014.57.6.500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Dongwoo Shin
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| |
Collapse
|