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Ripollés-Melchor J, Colomina MJ, Aldecoa C, Clau-Terre F, Galán-Menéndez P, Jiménez-López I, Jover-Pinillos JL, Lorente JV, Monge García MI, Tomé-Roca JL, Yanes G, Zorrilla-Vaca A, Escaraman D, García-Fernández J. A critical review of the perioperative fluid therapy and hemodynamic monitoring recommendations of the Enhanced Recovery of the Adult Pathway (RICA): A position statement of the fluid therapy and hemodynamic monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section (SHTF) of the Spanish Society of Anesthesiology and Critical Care (SEDAR). Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:458-466. [PMID: 37669701 DOI: 10.1016/j.redare.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/22/2022] [Indexed: 09/07/2023]
Abstract
In an effort to standardize perioperative management and improve postoperative outcomes of adult patients undergoing surgery, the Ministry of Health, through the Spanish Multimodal Rehabilitation Group (GERM), and the Aragonese Institute of Health Sciences, in collaboration with multiple Spanish scientific societies and based on the available evidence, published in 2021 the Spanish Intensified Adult Recovery (RICA) guideline. This document includes 12 perioperative measures related to fluid therapy and hemodynamic monitoring. Fluid administration and hemodynamic monitoring are not straightforward but are directly related to postoperative patient outcomes. The Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section (SHTF) of the Spanish Society of Anesthesiology and Critical Care (SEDAR) has reviewed these recommendations and concluded that they should be revised as they do not follow an adequate methodology.
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Affiliation(s)
| | - M J Colomina
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario de Bellvitge, Universidad de Barcelona, Barcelona, Spain
| | - C Aldecoa
- Grupo Español de Rehabilitación Multimodal (ReDGERM), Zaragoza, Spain; Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Río Hortega, Valladolid, Spain
| | - F Clau-Terre
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - P Galán-Menéndez
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - I Jiménez-López
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Jover-Pinillos
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Virgen de los Lirios, Alcoy, Spain
| | - J V Lorente
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - M I Monge García
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Jerez de la Frontera, Cádiz, Spain
| | - J L Tomé-Roca
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - G Yanes
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Zorrilla-Vaca
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Brigham and Women's Hospital, Boston, MA, United States
| | - D Escaraman
- Centro Médico Nacional La Raza, Mexico City, Mexico
| | - J García-Fernández
- Grupo de Fluidoterapia y Monitorización Hemodinámica de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, Spain; Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Ripollés-Melchor J, Aldecóa C, Lorente JV, Ruiz-Escobar A, Monge-García MI, Jiménez I, Jover-Pinillos JL, Galán-Menendez P, Tomé-Roca JL, Fernández-Valdes-Balgo P, Colomina MJ. Fluid challenges in operating room: A planned sub study of the Fluid Day observational study. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:311-318. [PMID: 37276966 DOI: 10.1016/j.redare.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Intraoperative fluid administration is a ubiquitous intervention in surgical patients. But inadequate fluid administration may lead to poor postoperative outcomes. Fluid challenges (FCs), in or outside the so-called goal-directed fluid therapy, allows testing the cardiovascular system and the need for further fluid administration. Our primary aim was to evaluate how anesthesiologists conduct FCs in the operating room in terms of type, volume, variables used to trigger a FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. METHODS This was a planned substudy of an observational study conducted in 131 centres in Spain in patients undergoing surgery. RESULTS A total of 396 patients were enrolled and analysed in the study. The median [interquartile range] amount of fluid given during a FC was 250ml (200-400). The main indication for FC was a decrease in systolic arterial pressure in 246 cases (62.2%). The second was a decrease in mean arterial pressure (54.4%). Cardiac output was used in 30 patients (7.58%), while stroke volume variation in 29 of 385 cases (7.32%). The response to the initial FC did not have an impact when prescribing further fluid administration. CONCLUSIONS The current indication and evaluation of FC in surgical patients is highly variable. Prediction of fluid responsiveness is not routinely used, and inappropriate variables are frequently evaluated for assessing the hemodynamic response to FC, which may result in deleterious effects.
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Affiliation(s)
- J Ripollés-Melchor
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain.
| | - C Aldecóa
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesiology and Surgical Critical Care, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - J V Lorente
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia and Critical Care, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - A Ruiz-Escobar
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M I Monge-García
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain; Edwards Lifesciences, Irvine, California, United States
| | - I Jiménez
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Jover-Pinillos
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Verge dels Lliris, Alcoy, Alicante, Spain
| | - P Galán-Menendez
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - J L Tomé-Roca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - P Fernández-Valdes-Balgo
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M J Colomina
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia and Critical Care, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Ripollés-Melchor J, Colomina MJ, Aldecoa C, Alonso-Cabello J, Alonso-Íñigo JM, Aya H, Basora M, Clau-Terre F, Del Cojo-Peces E, Cota-Delgado F, Ferrandis-Comes R, Galán-Menéndez P, García-López D, Garruti I, López IJ, Jover-Pinillos JL, Llau-Pitarch JV, Lorente JV, Mesquida J, Mojarro I, Monge-García MI, Montesinos-Fadrique SC, Muñoz-Rodes JL, de Nadal M, Ramasco F, Tomé-Roca JL, Pérez A, Uña-Orejón R, Yanes G, Zorrilla-Vaca A, Escarraman D, García-Fernández J. Research priorities in perioperative fluid therapy and hemodynamic monitoring: A Delphi Consensus Survey from the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section (SHTF) of the Spanish Society of Anesthesiology and Critical Care (SEDAR). Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:319-326. [PMID: 37279834 DOI: 10.1016/j.redare.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/23/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Research in fluid therapy and perioperative hemodynamic monitoring is difficult and expensive. The objectives of this study were to summarize these topics and to prioritize these topics in order of research importance. METHODS Electronic structured Delphi questionnaire over three rounds among 30 experts in fluid therapy and hemodynamic monitoring identified through the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care. RESULTS 77 topics were identified and ranked in order of prioritization. Topics were categorized into themes of crystalloids, colloids, hemodynamic monitoring and others. 31 topics were ranked as essential research priority. To determine whether intraoperative hemodynamic optimization algorithms based on the invasive or noninvasive Hypotension Prediction Index versus other management strategies could decrease the incidence of postoperative complications. As well as whether the use of renal stress biomarkers together with a goal-directed fluid therapy protocol could reduce hospital stay and the incidence of acute kidney injury in adult patients undergoing non-cardiac surgery, reached the highest consensus. CONCLUSIONS The Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care will use these results to carry out the research.
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Affiliation(s)
- J Ripollés-Melchor
- Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (ReDGERM), Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain.
| | - M J Colomina
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Universidad de Barcelona, Barcelona, Spain
| | - C Aldecoa
- Spanish Perioperative Audit and Research Network (ReDGERM), Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - H Aya
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - M Basora
- Hospital Clínico de Barcelona, Barcelona, Spain
| | - F Clau-Terre
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - E Del Cojo-Peces
- Hospital Área de Salud Don Benito y Villanueva, Don Benito, Badajoz, Spain
| | - F Cota-Delgado
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | - D García-López
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - I Garruti
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - I J López
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Jover-Pinillos
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de los Lirios, Alcoy, Alicante, Spain
| | | | - J V Lorente
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - J Mesquida
- Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain
| | - I Mojarro
- Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - M I Monge-García
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
| | - S C Montesinos-Fadrique
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Independent Researcher, Córdoba, Spain
| | | | - M de Nadal
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - F Ramasco
- Hospital Universitario La Princesa, Madrid, Spain
| | - J L Tomé-Roca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - A Pérez
- Hospital Universitario de Elche, Elche, Alicante, Spain
| | | | - G Yanes
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de los Lirios, Alcoy, Alicante, Spain
| | - A Zorrilla-Vaca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Brigham and Women's Hospital, Boston, United States
| | - D Escarraman
- Centro Médico Nacional La Raza, Mexico City, Mexico
| | - J García-Fernández
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Jover Pinillos JL, Basora Macaya M, Ripollés-Melchor J, Ferrandis Comes R, Llau Pitarch JV, Colomina Soler MJ. Perioperative colloids: From theory to practice. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:187-197. [PMID: 36858277 DOI: 10.1016/j.redare.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/10/2022] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Fluid administration is the cornerstone in hypovolemic patient's reanimation. Clinical guidelines restrict colloid administration favouring crystalloids. Currently, we don't know exactly which is the daily clinical practice during the perioperative period. The objective of this study is to describe perioperative use of colloids analysing possible reasons aiming to use them. MATERIAL AND METHODS Prospective, cross-section, national, multicentre observational study. Fluid Day sub-study. We enrolled all patient's older than 18 years old who underwent surgery during the 24 h of the 2-days study (February, 2019, 18th and 20th). We registered demographic data, comorbidities, anaesthetic and surgical procedure data, fluids administered, perioperative bleeding and monitoring type used during the perioperative period. RESULTS A total of 5928 cases were analysed and 542 patients (9.1%) received any type of colloids, being hydroxiethyl-starch the most frequently used (5.1%). Patients receiving colloids suffered more longing surgery (150 [90-255] vs. 75 [45-120] min), were urgently operated (13.7 vs. 7.5%) and were more frequent classified as high risk (22 vs. 4.8%). Their recovery was mostly in critical care units (45.1 vs.15.8%). Patients with bleeding less than 500 ml received colloids in a percentage of 5.9 versus 45.9% when this figure was overcome. Patients who received colloids were anaemic more frequently: 29.4 vs. 16.3%. Colloids administration had a higher risk for transfusion (OR 15.7). Advanced monitoring also increased the risk for receiving colloids (OR 9.43). CONCLUSIONS In our environment with routine clinical practice, colloids administration is limited and close linked to perioperative bleeding.
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Affiliation(s)
- J L Jover Pinillos
- Servicio de Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy, Alicante, Spain.
| | - M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, Spain
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Ferrandis Comes
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari La Fe, Valencia, Spain
| | - J V Llau Pitarch
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari Dr. Pesset, Valencia, Spain
| | - M J Colomina Soler
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Ripollés-Melchor J, Zorrilla-Vaca A, Lorente JV, Weiss R. Is it time to incorporate Kidney Disease Improving Global Outcomes (KDIGO) bundles into Enhanced Recovery After Surgery (ERAS) protocols for colorectal surgery? Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:125-128. [PMID: 36842696 DOI: 10.1016/j.redare.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/30/2021] [Indexed: 02/28/2023]
Affiliation(s)
- J Ripollés-Melchor
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM); Fluid Therapy and Hemodynamic Group of the Hemostasis, Transfusion Medicine and Fluid Therapy Section, Spanish Society of Anesthesia and Critical Care (SEDAR).
| | - A Zorrilla-Vaca
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J V Lorente
- Fluid Therapy and Hemodynamic Group of the Hemostasis, Transfusion Medicine and Fluid Therapy Section, Spanish Society of Anesthesia and Critical Care (SEDAR); Department of Anesthesia and Critical Care, Juan Ramón Jiménez Hospital, Huelva, Spain
| | - R Weiss
- Department of Anesthesia and Critical Care, Juan Ramón Jiménez Hospital, Huelva, Spain; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany; Renal Protection Network, RAPNET
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Lorente JV, Ripollés-Melchor J, Aldecoa C, Abad-Motos A. Effect of the first wave of COVID-19 on the implementation of Enhanced Recovery After Surgery (ERAS) protocols based on perceptions of healthcare professionals. Revista Española de Anestesiología y Reanimación (English Edition) 2022; 69:374-376. [PMID: 35760690 PMCID: PMC9226966 DOI: 10.1016/j.redare.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022]
Affiliation(s)
- J V Lorente
- Anesthesia and Critical Care Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain.
| | - J Ripollés-Melchor
- Anesthesia and Critical Care Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - C Aldecoa
- Anesthesia and Surgical Intensive Care, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - A Abad-Motos
- Anesthesia and Critical Care Department, Hospital Universitario Infanta Leonor, Madrid, Spain
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Ripollés-Melchor J, Fernández Dorado F, Rubio Aguilera AI, Criado Camargo A, Chico García M, Abad-Motos A, Abad-Gurumeta A. Association between preoperative baseline pulse pressure and estimated pulse wave velocity and acute renal failure and mortality following colorectal surgery. A single-centre observational study. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:564-575. [PMID: 34844912 DOI: 10.1016/j.redare.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 02/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Elevated pulse wave velocity is a haemodynamic parameter considered to be a risk factor for the development of cardiovascular alterations, while pulse pressure is a predictor of cardiovascular complications and development of acute renal failure after both cardiac and non-cardiac surgery. Our objective was to determine whether baseline pulse pressure and estimated pulse wave velocity are associated with renal failure and 30-day mortality following colorectal surgery. METHODS Retrospective observational study. A total of 816 adult patients undergoing elective colorectal surgery were evaluated by performing multivariable logistic regression analysis to determine whether baseline pulse pressure and estimated pulse wave velocity were independently associated with complications, specifically renal failure and 30-day postoperative mortality, and whether pulse pressure and estimated pulse wave velocity thresholds correlated with outcomes. RESULTS Baseline pulse pressure was 56.00 mmHg (45.00;68.00) and estimated pulse wave velocity was 13.16 m/s (10.76;14.85). Baseline pulse pressure was not associated with acute renal failure or mortality in the univariate model. Baseline estimated pulse wave velocity was not associated with complications, acute renal failure, or mortality. An estimated pulse wave velocity of 13.78 m/s significantly predicted acute renal failure (AUC 0.654 [0.588-0.720]) and mortality (AUC 0.698 [0.600-0.796]). CONCLUSIONS Neither pulse pressure nor preoperative baseline estimated pulse wave velocity were associated with acute renal failure or postoperative mortality. The preoperative estimated pulse wave velocity threshold of 13.78 m/s predicted an increased risk of acute renal failure and postoperative mortality.
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Affiliation(s)
- J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Madrid, Spain.
| | | | | | | | | | - A Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Madrid, Spain
| | - A Abad-Gurumeta
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Madrid, Spain
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Lorente JV, Ripollés-Melchor J, Aldecoa C, Abad-Motos A. “Efecto de la primera ola de la pandemia COVID-19 en la aplicación de los protocolos de recuperación intensificada perioperatoria según la percepción de los profesionales sanitarios”. ACTA ACUST UNITED AC 2021; 69:374-376. [PMID: 34658448 PMCID: PMC8501220 DOI: 10.1016/j.redar.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J V Lorente
- Anesthesia and Critical Care Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - J Ripollés-Melchor
- Anesthesia and Critical Care Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - C Aldecoa
- Anesthesia and Surgical Intensive Care. Hospital Universitario Rio Hortega, Valladolid, Spain
| | - A Abad-Motos
- Anesthesia and Critical Care Department, Hospital Universitario Infanta Leonor, Madrid, Spain
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Ripollés-Melchor J, Aldecoa C, Alday-Muñoz E, Del Río S, Batalla A, Del-Cojo-Peces E, Uña-Orejón R, Muñoz-Rodés JL, Lorente JV, Espinosa ÁV, Ferrando-Ortolà C, Jover JL, Abad-Gurumeta A, Ramírez-Rodríguez JM, Abad-Motos A. Intraoperative crystalloid utilization variability and association with postoperative outcomes: A post hoc analysis of two multicenter prospective cohort studies. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:373-383. [PMID: 34364826 DOI: 10.1016/j.redare.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes. METHODS We extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS). RESULTS 7580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval 1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOS CONCLUSIONS: A wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.
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Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.
| | - C Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Cuidados Críticos, Hospital Universitario Río Hortega, Valladolid, Spain
| | - E Alday-Muñoz
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario La Princesa, Madrid, Spain
| | - S Del Río
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - A Batalla
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Universitario Sant Pau, Barcelona, Spain
| | - E Del-Cojo-Peces
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Don Benito Vilanueva, Badajoz, Spain
| | - R Uña-Orejón
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia, Hospital Universitario La Paz, Madrid, Spain
| | - J L Muñoz-Rodés
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital General Universitario de Elche, Elche, Spain
| | - J V Lorente
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain
| | - Á V Espinosa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Department of Cardiothoracic and Vascular Anesthesia and Critical Care. MKCC Mohammed Bin Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain
| | - C Ferrando-Ortolà
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - J L Jover
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Departamento de Anestesia y Medicina Perioperatoria, Hospital Virgen de Los Lirios, Alcoy, Alicante, Spain
| | - A Abad-Gurumeta
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
| | - J M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Departamento de Cirugía, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - A Abad-Motos
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
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10
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Ripollés-Melchor J, Fernández Dorado F, Rubio Aguilera AI, Criado Camargo A, Chico García M, Abad-Motos A, Abad-Gurumeta A. Association between preoperative baseline pulse pressure and estimated pulse wave velocity and acute renal failure and mortality following colorectal surgery. A single-centre observational study. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(21)00103-1. [PMID: 34289958 DOI: 10.1016/j.redar.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Elevated pulse wave velocity is a haemodynamic parameter considered to be a risk factor for the development of cardiovascular alterations, while pulse pressure is a predictor of cardiovascular complications and development of acute renal failure after both cardiac and non-cardiac surgery. Our objective was to determine whether baseline pulse pressure and estimated pulse wave velocity are associated with renal failure and 30-day mortality following colorectal surgery. METHODS Retrospective observational study. A total of 816 adult patients undergoing elective colorectal surgery were evaluated by performing multivariable logistic regression analysis to determine whether baseline pulse pressure and estimated pulse wave velocity were independently associated with complications, specifically renal failure and 30-day postoperative mortality, and whether pulse pressure and estimated pulse wave velocity thresholds correlated with outcomes. RESULTS Baseline pulse pressure was 56.00mmHg (45.00;68.00) and estimated pulse wave velocity was 13.16m/s (10.76;14.85). Baseline pulse pressure was not associated with acute renal failure or mortality in the univariate model. Baseline estimated pulse wave velocity was not associated with complications, acute renal failure, or mortality. An estimated pulse wave velocity of 13.78m/s significantly predicted acute renal failure (AUC 0.654 [0.588-0.720]) and mortality (AUC 0.698 [0.600-0.796]). CONCLUSIONS Neither pulse pressure nor preoperative baseline estimated pulse wave velocity were associated with acute renal failure or postoperative mortality. The preoperative estimated pulse wave velocity threshold of 13.78m/s predicted an increased risk of acute renal failure and postoperative mortality.
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Affiliation(s)
- J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM). Grupo Español de Rehabilitación Multimodal (GERM), Madrid, España.
| | | | | | | | | | - A Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM). Grupo Español de Rehabilitación Multimodal (GERM), Madrid, España
| | - A Abad-Gurumeta
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM). Grupo Español de Rehabilitación Multimodal (GERM), Madrid, España
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11
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Ripollés-Melchor J, Aldecoa C, Alday-Muñoz E, Del Río S, Batalla A, Del-Cojo-Peces E, Uña-Orejón R, Muñoz-Rodés JL, Lorente JV, Espinosa ÁV, Ferrando-Ortolà C, Jover JL, Abad-Gurumeta A, Ramírez-Rodríguez JM, Abad-Motos A. Intraoperative crystalloid utilization variability and association with postoperative outcomes: A post hoc analysis of two multicenter prospective cohort studies. ACTA ACUST UNITED AC 2021. [PMID: 33752893 DOI: 10.1016/j.redar.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes. METHODS We extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS). RESULTS 7,580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOS CONCLUSIONS: A wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.
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Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España.
| | - C Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia y Cuidados Críticos, Hospital Universitario Río Hortega, Valladolid, España
| | - E Alday-Muñoz
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario de La Princesa, Madrid, España
| | - S Del Río
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - A Batalla
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia, Hospital Universitario Sant Pau, Barcelona, España
| | - E Del-Cojo-Peces
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Departamento de Anestesia, Hospital Don Benito Villanueva, Badajoz, España
| | - R Uña-Orejón
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Departamento de Anestesia, Hospital Universitario La Paz, Madrid, España
| | - J L Muñoz-Rodés
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia y Medicina Perioperatoria, Hospital General Universitario de Elche, Elche, España
| | - J V Lorente
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Juan Ramón Jimenez, Huelva, España
| | - Á V Espinosa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Department of Cardiothoracic and Vascular Anesthesia and Critical Care, MKCC Mohammed Bin Khalifa Cardiac Center, Royal Medical Services, Awali, Kingdom of Bahrain
| | - C Ferrando-Ortolà
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - J L Jover
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Departamento de Anestesia y Medicina Perioperatoria, Hospital Virgen de Los Lirios, Alcoy, Alicante, España
| | - A Abad-Gurumeta
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España
| | - J M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Departamento de Cirugía, Hospital Universitario Lozano Blesa, Zaragoza, España
| | - A Abad-Motos
- Departamento de Anestesia y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España
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12
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Basora Macaya M, Jover Pinillos JL, Ripollés-Melchor J. Hydroxyethyl starch 2020. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:1-4. [PMID: 32553517 DOI: 10.1016/j.redar.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Affiliation(s)
- M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España.
| | - J L Jover Pinillos
- Servicio Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy, Alicante, España
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España
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13
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Abad-Motos A, Ripollés-Melchor J, Jericó C, Basora M, Aldecoa C, Cabellos-Olivares M, Navarro-Pérez R, Bisbe E, García-Erce JA. Patient Blood Management for primary hip and knee replacement. A survey among POWER.2 study researchers. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:237-244. [PMID: 32165061 DOI: 10.1016/j.redar.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Implementation of Patient Blood Management programs remain variable in Europe, and even in centres with well-established PBM programs variability exists in transfusion practices. OBJECTIVES AND METHODS We conducted a survey in order to assess current practice in perioperative Patient Blood Management in patients undergoing total hip and knee replacement among researchers involved in POWER.2 Study in Spain (an observational prospective study evaluating enhanced recovery pathways in orthopaedic surgery). RESULTS A total of 322 responses were obtained (37.8%). Half of responders check Haemoglobin levels in patients at least 4 weeks before surgery; 35% treat all anaemic patients, although 99.7% consider detection and treatment of preoperative anaemia could influence the postoperative outcomes. Lack of infrastructure (76%) and lack of time (51%) are the main stated reasons not to treat anaemic patients. Iron status is routinely checked by 19% before surgery, and 36% evaluate it solely in the anaemic patient. Hb<9.9 g/dl is the threshold to delay surgery for 61% of clinicians, and 22% would consider transfusing preoperatively clinically stable patients without active bleeding. The threshold to transfuse patients without cardiovascular disease is 8 g/dl for 43%, and 7 g/dl for 34% of the responders; 75% of clinicians consider they use "restrictive thresholds", and 90% follow the single unit transfusion policy. CONCLUSIONS The results of our survey show variability in clinical practice in Patient Blood Management in major orthopaedic surgery, despite being the surgery with the greatest tradition in these programs.
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Affiliation(s)
- A Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España.
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
| | - M Basora
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari, Barcelona, España; Anemia Working Group España (AWGE)
| | - C Aldecoa
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Valladolid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - M Cabellos-Olivares
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Guadalajara, Guadalajara, España
| | - R Navarro-Pérez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Clínico San Carlos, Madrid, España
| | - E Bisbe
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, España; Anemia Working Group España (AWGE)
| | - J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
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14
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Colomina MJ, Guilabert P, Ripollés-Melchor J, Jover JL, Basora M, Llau JV, Casinello C, Ferrandis R. Fluid therapy in the surgical patient in our environment. Reporting on the Fluid Day Study. ACTA ACUST UNITED AC 2019; 66:119-121. [PMID: 30665797 DOI: 10.1016/j.redar.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitari Bellvitge, Barcelona, España.
| | - P Guilabert
- Servicio de Anestesiología y Reanimación, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España
| | - J L Jover
- Servicio de Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy (Alicante), España
| | - M Basora
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | - J V Llau
- Servicio de Anestesiología y Reanimación, Hospital Universitari Dr. Peset, Valencia, España
| | - C Casinello
- Servicio de Anestesiología y Reanimación, Hospital Miguel Servet, Zaragoza, España
| | - R Ferrandis
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
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15
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Ripollés-Melchor J, García-Erce JA, Vincent JL. Transfusion thresholds and red blood cells transfusion focused on tissue oxygenation. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:363-365. [PMID: 29657065 DOI: 10.1016/j.redar.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Affiliation(s)
- J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España.
| | - J A García-Erce
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común», España; Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org), España; Grupo idiPAZ de «Investigación en PBM», Madrid, España
| | - J-L Vincent
- Department of Intensive Care, Erasme University Hospital (Université Libre de Bruxelles), Bruselas, Bélgica
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16
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Calvo-Vecino J, Ripollés-Melchor J, Mythen M, Casans-Francés R, Balik A, Artacho J, Martínez-Hurtado E, Serrano Romero A, Fernández Pérez C, Asuero de Lis S, Errazquin AT, Gil Lapetra C, Motos AA, Reche EG, Medraño Viñas C, Villaba R, Cobeta P, Ureta E, Montiel M, Mané N, Martínez Castro N, Horno GA, Salas RA, Bona García C, Ferrer Ferrer ML, Franco Abad M, García Lecina AC, Antón JG, Gascón GH, Peligro Deza J, Pascual LP, Ruiz Garcés T, Roberto Alcácer AT, Badura M, Terrer Galera E, Fernández Casares A, Martínez Fernández MC, Espinosa Á, Abad-Gurumeta A, Feldheiser A, López Timoneda F, Zuleta-Alarcón A, Bergese S. Effect of goal-directed haemodynamic therapy on postoperative complications in low–moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial). Br J Anaesth 2018; 120:734-744. [DOI: 10.1016/j.bja.2017.12.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/20/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023] Open
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17
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Ripollés-Melchor J, Chappell D, Aya HD, Espinosa Á, Mythen MG, Abad-Gurumeta A, Bergese SD, Casans-Francés R, Calvo-Vecino JM. Erratum to: "Fluid therapy recommendations for major abdominal surgery. Via RICA recommendations revisited. Part II: Goal directed hemodynamic therapy. Rationale for optimising intravascular volume" [Rev Esp Anestesiol Reanim. 2017;64(6):339-347]. ACTA ACUST UNITED AC 2017; 64:424. [PMID: 28709477 DOI: 10.1016/j.redar.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España.
| | - D Chappell
- Departamento de Anestesia, Hospital Universitario LMU de Múnich, Múnich, Alemania
| | - H D Aya
- Departamento de Cuidados Intensivos, St George's University Hospitals, NHS Foundation Trust, Londres, Reino Unido
| | - Á Espinosa
- Departamento de Anestesia Cardiovascular y Torácica, y Cuidados Intensivos, Bahrain Defence Force Hospital, Riffa, Reino de Baréin
| | - M G Mythen
- University College London Hospital, National Institute for Health Research, Biomedical Research Centre, Londres, Reino Unido
| | - A Abad-Gurumeta
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España
| | - S D Bergese
- Departamento de Anestesia y Neurocirugía, Wexner Medical Center, The Ohio State University, Columbus, OH, Estados Unidos
| | - R Casans-Francés
- Departamento de Anestesia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J M Calvo-Vecino
- Departamento de Anestesia, Complejo Asistencial Universitario de Salamanca, Universidad de Salamanca (CAUSA), Salamanca, España
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18
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Ripollés-Melchor J, Chappell D, Aya HD, Espinosa Á, Mythen MG, Abad-Gurumeta A, Bergese SD, Casans-Francés R, Calvo-Vecino JM. Erratum to: "Fluid therapy recommendations for major abdominal surgery. Via RICA recommendations revisited. Part III: Goal directed hemodynamic therapy. Rationale for maintaining vascular tone and contractility" [Rev Esp Anestesiol Reanim. 2017;64(6):348-359]. ACTA ACUST UNITED AC 2017; 64:425. [PMID: 28709478 DOI: 10.1016/j.redar.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España.
| | - D Chappell
- Departamento de Anestesia, Hospital Universitario LMU de Múnich, Múnich, Alemania
| | - H D Aya
- Departamento de Cuidados Intensivos, St George's University Hospitals, NHS Foundation Trust, Londres, Reino Unido
| | - Á Espinosa
- Departamento de Anestesia Cardiovascular y Torácica, y Cuidados Intensivos, Bahrain Defence Force Hospital, Riffa, Reino de Baréin
| | - M G Mythen
- University College London Hospital, National Institute of Health Research, Biomedical Research Centre, Londres, Reino Unido
| | - A Abad-Gurumeta
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España
| | - S D Bergese
- Departamento de Anestesia y Neurocirugía, Wexner Medical Center, The Ohio State University, Columbus, OH, Estados Unidos
| | - R Casans-Francés
- Departamento de Anestesia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J M Calvo-Vecino
- Departamento de Anestesia, Complejo Asistencial Universitario de Salamanca, Universidad de Salamanca (CAUSA), Salamanca, España
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Ripollés-Melchor J, Chappell D, Espinosa Á, Mythen MG, Abad-Gurumeta A, Bergese SD, Casans-Francés R, Calvo-Vecino JM. Erratum to: "Perioperative fluid therapy recommendations for major abdominal surgery. Via RICA recommendations revisited. Part I: Physiological background" [Rev Esp Anestesiol Reanim. 2017;64(6):328-338]. ACTA ACUST UNITED AC 2017; 64:423. [PMID: 28709476 DOI: 10.1016/j.redar.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/16/2022]
Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España.
| | - D Chappell
- Departamento de Anestesia, Hospital Universitario LMU de Múnich, Múnich, Alemania
| | - Á Espinosa
- Departamento de Anestesia Cardiovascular y Torácica, y Cuidados Intensivos, Bahrain Defence Force Hospital, Riffa, Reino de Baréin
| | - M G Mythen
- University College London Hospital, National Institute of Health Research, Biomedical Research Centre, Londres, Reino Unido
| | - A Abad-Gurumeta
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España
| | - S D Bergese
- Departamento de Anestesia y Neurocirugía, Wexner Medical Center, The Ohio State University, Columbus, OH, Estados Unidos
| | - R Casans-Francés
- Departamento de Anestesia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J M Calvo-Vecino
- Departamento de Anestesia, Complejo Asistencial de Salamanca, Universidad de Salamanca, Salamanca, España
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Ripollés-Melchor J, Chappell D, Espinosa Á, Mhyten MG, Abad-Gurumeta A, Bergese SD, Casans-Francés R, Calvo-Vecino JM. Perioperative fluid therapy recommendations for major abdominal surgery. Via RICA recommendations revisited. Part I: Physiological background. Rev Esp Anestesiol Reanim 2017; 64:328-338. [PMID: 28364973 DOI: 10.1016/j.redar.2017.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 06/07/2023]
Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España.
| | - D Chappell
- Departamento de Anestesia, Hospital Universitario LMU de Múnich, Múnich, Alemania
| | - Á Espinosa
- Departamento de Anestesia Cardiovascular y Torácica, y Cuidados Intensivos, Bahrain Defence Force Hospital, Riffa, Reino de Baréin
| | - M G Mhyten
- University College London Hospital, National Institute of Health Research, Biomedical Research Centre, Londres, Reino Unido
| | - A Abad-Gurumeta
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España
| | - S D Bergese
- Departamento de Anestesia y Neurocirugía, Wexner Medical Center, The Ohio State University, Columbus, OH, Estados Unidos
| | - R Casans-Francés
- Departamento de Anestesia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J M Calvo-Vecino
- Departamento de Anestesia, Complejo Asistencial de Salamanca, Universidad de Salamanca, Salamanca, España
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Ripollés-Melchor J, Chappell D, Aya HD, Espinosa Á, Mhyten MG, Abad-Gurumeta A, Bergese SD, Casans-Francés R, Calvo-Vecino JM. Fluid therapy recommendations for major abdominal surgery. Via RICA recommendations revisited. Part III: Goal directed hemodynamic therapy. Rationale for maintaining vascular tone and contractility. Rev Esp Anestesiol Reanim 2017; 64:348-359. [PMID: 28343682 DOI: 10.1016/j.redar.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 06/06/2023]
Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España.
| | - D Chappell
- Departamento de Anestesia, Hospital Universitario LMU de Múnich, Múnich, Alemania
| | - H D Aya
- Departamento de Cuidados Intensivos, St George's University Hospitals, NHS Foundation Trust, Londres, Reino Unido
| | - Á Espinosa
- Departamento de Anestesia Cardiovascular y Torácica, y Cuidados Intensivos, Bahrain Defence Force Hospital, Riffa, Reino de Baréin
| | - M G Mhyten
- University College London Hospital, National Institute of Health Research, Biomedical Research Centre, Londres, Reino Unido
| | - A Abad-Gurumeta
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España
| | - S D Bergese
- Departamento de Anestesia y Neurocirugía, Wexner Medical Center, The Ohio State University, Columbus, OH, Estados Unidos
| | - R Casans-Francés
- Departamento de Anestesia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J M Calvo-Vecino
- Departamento de Anestesia, Complejo Asistencial Universitario de Salamanca, Universidad de Salamanca (CAUSA), Salamanca, España
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Ripollés-Melchor J, Chappell D, Aya HD, Espinosa Á, Mhyten MG, Abad-Gurumeta A, Bergese SD, Casans-Francés R, Calvo-Vecino JM. Fluid therapy recommendations for major abdominal surgery. Via RICA recommendations revisited. Part II: Goal directed hemodynamic therapy. Rationale for optimising intravascular volume. Rev Esp Anestesiol Reanim 2017; 64:339-347. [PMID: 28343684 DOI: 10.1016/j.redar.2017.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 06/06/2023]
Affiliation(s)
- J Ripollés-Melchor
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España.
| | - D Chappell
- Departamento de Anestesia, Hospital Universitario LMU de Múnich, Múnich, Alemania
| | - H D Aya
- Departamento de Cuidados Intensivos, St George's University Hospitals, NHS Foundation Trust, Londres, Reino Unido
| | - Á Espinosa
- Departamento de Anestesia Cardiovascular y Torácica, y Cuidados Intensivos, Bahrain Defence Force Hospital, Riffa, Reino de Baréin
| | - M G Mhyten
- University College London Hospital, National Institute for Health Research, Biomedical Research Centre, Londres, Reino Unido
| | - A Abad-Gurumeta
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España
| | - S D Bergese
- Departamento de Anestesia y Neurocirugía, Wexner Medical Center, The Ohio State University, Columbus, OH, Estados Unidos
| | - R Casans-Francés
- Departamento de Anestesia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J M Calvo-Vecino
- Departamento de Anestesia, Complejo Asistencial Universitario de Salamanca, Universidad de Salamanca (CAUSA), Salamanca, España
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Abad-Gurumeta A, Ripollés-Melchor J, Casans-Francés R, Calvo-Vecino JM. Monitoring of nociception, reality or fiction? ACTA ACUST UNITED AC 2017; 64:406-414. [PMID: 28341079 DOI: 10.1016/j.redar.2017.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 11/18/2022]
Abstract
There are currently various projects underway that attempt to monitor the nociceptive responses caused by surgical stress and ensure patients the best analgesic conditions. The systemic response to surgical stress has repercussions in the postoperative period, such as worse pain control, delayed recovery, greater complications, longer stay in resuscitation and hospital units, and increased healthcare costs. However, treatment with higher doses of opioids than necessary may lead to slower awakening, increased drowsiness and adverse effects, as well as situations of postoperative opioid-induced hyperalgesia. There are 2 large groups of nociceptive monitoring according to the origin of the theoretical objective of monitoring response to the stimulus, that may derive from changes in the electroencephalogram or the response of the autonomic nervous system.
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Affiliation(s)
- A Abad-Gurumeta
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España.
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España
| | - R Casans-Francés
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J M Calvo-Vecino
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Salamanca, Salamanca, España
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Ripollés-Melchor J, Rodrigo Pérez-Tabernero A, Casans Francés R, Martínez Hurtado E, Aracil Escoda N, Calvo Vecino JM. Abstract PR617. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492996.76535.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ripollés-Melchor J, Casans-Francés R, Espinosa A, Abad-Gurumeta A, Feldheiser A, López-Timoneda F, Calvo-Vecino JM. Goal directed hemodynamic therapy based in esophageal Doppler flow parameters: A systematic review, meta-analysis and trial sequential analysis. Rev Esp Anestesiol Reanim 2016; 63:384-405. [PMID: 26873025 DOI: 10.1016/j.redar.2015.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/14/2015] [Accepted: 07/18/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Numerous studies have compared perioperative esophageal doppler monitoring (EDM) guided intravascular volume replacement strategies with conventional clinical volume replacement in surgical patients. The use of the EDM within hemodynamic algorithms is called 'goal directed hemodynamic therapy' (GDHT). METHODS Meta-analysis of the effects of EDM guided GDHT in adult non-cardiac surgery on postoperative complications and mortality using PRISMA methodology. A systematic search was performed in Medline, PubMed, EMBASE, and the Cochrane Library (last update, March 2015). INCLUSION CRITERIA Randomized clinical trials (RCTs) in which perioperative GDHT was compared to other fluid management. PRIMARY OUTCOMES Overall complications. SECONDARY OUTCOMES Mortality; number of patients with complications; cardiac, renal and infectious complications; incidence of ileus. Studies were subjected to quantifiable analysis, pre-defined subgroup analysis (stratified by surgery, type of comparator and risk); pre-defined sensitivity analysis and trial sequential analysis (TSA). RESULTS Fifty six RCTs were initially identified, 15 fulfilling the inclusion criteria, including 1,368 patients. A significant reduction was observed in overall complications associated with GDHT compared to other fluid therapy (RR=0.75; 95%CI: 0.63-0.89; P=0.0009) in colorectal, urological and high-risk surgery compared to conventional fluid therapy. No differences were found in secondary outcomes, neither in other subgroups. The impact on preventing the development of complications in patients using EDM is high, causing a relative risk reduction (RRR) of 50% for a number needed to treat (NNT)=6. CONCLUSIONS GDHT guided by EDM decreases postoperative complications, especially in patients undergoing colorectal surgery and high-risk surgery. However, no differences versus restrictive fluid therapy and in intermediate-risk patients were found.
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Affiliation(s)
- J Ripollés-Melchor
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Universitario Infanta Leonor, Madrid, España.
| | - R Casans-Francés
- Facultad de Medicina, Universidad de Zaragoza. Servicio de Anestesia, Hospital Universitario Lozano Blesa, Zaragoza, España
| | - A Espinosa
- Department of Anesthesia, Center of Vascular and Thoracic Surgery and Intensive Care, Örebro University Hospital, Örebro, Suecia
| | - A Abad-Gurumeta
- Servicio de Anestesia, Hospital Universitario La Paz, Madrid, España
| | - A Feldheiser
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte and Campus Charité Virchow-Klinikum, Berlín, Alemania
| | - F López-Timoneda
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Clínico Universitario San Carlos, Madrid, España
| | - J M Calvo-Vecino
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Universitario Infanta Leonor, Madrid, España
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Ripollés-Melchor J, Casans-Francés R, Abad-Gurumeta A, Suárez-de-la-Rica A, Ramírez-Rodríguez JM, López-Timoneda F, Calvo-Vecino JM. Spanish survey on enhanced recovery after surgery. Rev Esp Anestesiol Reanim 2016; 63:376-383. [PMID: 26796041 DOI: 10.1016/j.redar.2015.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/01/2015] [Accepted: 09/17/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aim of this study was to determine the interest in ERAS protocols, and the extent to which clinicians are familiar with and apply these protocols during perioperative care. MATERIALS AND METHODS Free access survey hosted on the Spanish Society of Anesthesiology and Critical Care; Spanish Association of Surgeons and Spanish Society of Enteral and Parenteral nutrition and ERAS Spain (GERM) websites conducted between September and December 2014. RESULTS The survey was answered by 272 professionals (44.5% anaesthetists, 45.2% general surgeons) from 110 hospitals, 73% of whom had experience in ERAS protocols. Most (86.1%) had specific knowledge of ERAS protocols, whereas only 50.9% were familiar with ERAS recommendations and 42.4% with GERM recommendations. Most (73.1%) respondents reported that ERAS protocols are performed in their hospitals, mainly in colorectal surgery (93%), and 52.2% reported that GERM/ERAS recommendations are followed. Nearly all (95.5%) would be interested in the development of multidisciplinary national guidelines. Less than half (46.6%) perform preoperative nutritional assessment, albeit without a universal malnutrition screening method (56.8%). Preoperative loading with carbohydrate drinks is carried out in only 51.4% of cases; nasogastric tube and drainage are avoided (79.3%), prophylaxis for postoperative nausea and vomiting (73.4%), goal directed fluid therapy (73.3%), and active normothermia maintenance (87.4%) are performed. In most cases, mobilization (90.1%) and early feeding (87.9%) are performed. The leading causes of protocol failure are postoperative nausea and vomiting (46.5%) and ileus (58.9%). CONCLUSION Clinicians in Spain are familiar with fast track protocols, although there is no overall consensus, and hospitals do not adhere to existing guidelines. Overall compliance with the items of the protocol is adequate, although perioperative nutritional management is poor.
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Affiliation(s)
- J Ripollés-Melchor
- Department of Anesthesia, Infanta Leonor University Hospital, Complutense University of Madrid, Madrid, Spain.
| | - R Casans-Francés
- Department of Anesthesia, Lozano Blesa University Hospital, University of Zaragoza, Zaragoza, Spain
| | - A Abad-Gurumeta
- Department of Anesthesia, La Paz University Hospital, Madrid, Spain
| | | | - J M Ramírez-Rodríguez
- Department of Surgery, Lozano Blesa University Hospital, University of Zaragoza, Zaragoza, Spain
| | - F López-Timoneda
- Department of Anesthesia, Clínico San Carlos University Hospital, Complutense University of Madrid, Madrid, Spain
| | - J M Calvo-Vecino
- Department of Anesthesia, Infanta Leonor University Hospital, Complutense University of Madrid, Madrid, Spain
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Abad-Gurumeta A, Ripollés-Melchor J, Casans-Francés R, Espinosa A, Martínez-Hurtado E, Fernández-Pérez C, Ramírez JM, López-Timoneda F, Calvo-Vecino JM. A systematic review of sugammadex vs neostigmine for reversal of neuromuscular blockade. Anaesthesia 2016; 70:1441-52. [PMID: 26558858 DOI: 10.1111/anae.13277] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/28/2022]
Abstract
We reviewed systematically sugammadex vs neostigmine for reversing neuromuscular blockade. We included 17 randomised controlled trials with 1553 participants. Sugammadex reduced all signs of residual postoperative paralysis, relative risk (95% CI) 0.46 (0.29-0.71), p = 0.0004 and minor respiratory events, relative risk (95% CI) 0.51 (0.32-0.80), p = 0.0034. There was no difference in critical respiratory events, relative risk (95% CI) 0.13 (0.02-1.06), p = 0.06. Sugammadex reduced drug-related side-effects, relative risk (95% CI) 0.72 (0.54-0.95), p = 0.02. There was no difference in the rate of postoperative nausea or the rate of postoperative vomiting, relative risk (95% CI) 0.94 (0.79-1.13), p = 0.53, and 0.87 (0.65-1.17), p = 0.36 respectively.
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Affiliation(s)
- A Abad-Gurumeta
- Department of Anaesthesia, Hospital Universitario la Paz, Madrid, Spain
| | - J Ripollés-Melchor
- Department of Anaesthesia, Complutense University of Madrid, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anaesthesia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Espinosa
- Department of Anaesthesia, Örebro University Hospital, Örebro, Sweden
| | - E Martínez-Hurtado
- Department of Anaesthesia, Complutense University of Madrid, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - C Fernández-Pérez
- Department of Consultant Preventive Medicine and Public Health, Complutense University of Madrid, Madrid, Spain
| | - J M Ramírez
- Department of Colorectal Surgery, University of Zaragoza, Zaragoza, Spain
| | - F López-Timoneda
- Department of Anaesthesia, Complutense University of Madrid, Hospital Clínico San Carlos, Madrid, Spain
| | - J M Calvo-Vecino
- Department of Anaesthesia, Complutense University of Madrid, Hospital Universitario Infanta Leonor, Madrid, Spain
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