A Double-Blind Randomized Controlled Clinical Trial to Assess the Effect of Doppler Optimized Intraoperative Fluid Management on Outcome Following Radical Cystectomy

Pillai, Praveen; McEleavy, Irene; Gaughan, Matthew; Snowden, Christopher; Nesbitt, Ian; Durkan, Garrett; Johnson, Mark; Cosgrove, J. F.; Thorpe, Andrew

doi:10.1016/j.juro.2011.07.093

Cited by 115 publications

(82 citation statements)

References 24 publications

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“…Eight trials [26, 29, 30, 46, 50, 53, 54, 56] used pulmonary arterial catheters for monitoring; fourteen trials [3, 11, 14, 32, 33, 36, 42, 44, 48, 49, 51, 55, 62, 64] used esophageal Doppler monitoring; fifteen trials [3, 12, 27, 28, 31, 38, 39, 41, 43, 45, 52, 59–61, 65] used self-calibrating/calibrated pulse contour analysis monitoring; and the remaining eight trials used other monitors, including arterial lines plus monitoring equipment [40], central lines and arterial line sampling [34, 37, 57], pulse oximeters [35, 58], and other noninvasive monitors [13, 47]. Three types of goals were used in the majority of included trials, including DO 2 I and/or cardiac index [13, 26, 29, 30, 43, 46, 50, 53, 54, 56, 59], optimal SV [1, 11, 28, 32, 33, 36, 38, 39, 42, 44, 48, 49, 51, 55], and dynamic measures of preload responsiveness (e.g., PPV, SVV, PVI) [12, 27, 31, 35, 40, 41, 45, 52, 58, 60, 61, 65].…”

Section: Resultsmentioning

confidence: 99%

Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery—a systematic review and meta-analysis of randomized controlled trials

et al. 2017

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BackgroundGoal-directed hemodynamic therapy (GDHT) has been used in the clinical setting for years. However, the evidence for the beneficial effect of GDHT on postoperative recovery remains inconsistent. The aim of this systematic review and meta-analysis was to evaluate the effect of perioperative GDHT in comparison with conventional fluid therapy on postoperative recovery in adults undergoing major abdominal surgery.MethodsRandomized controlled trials (RCTs) in which researchers evaluated the effect of perioperative use of GDHT on postoperative recovery in comparison with conventional fluid therapy following abdominal surgery in adults (i.e., >16 years) were considered. The effect sizes with 95% CIs were calculated.ResultsForty-five eligible RCTs were included. Perioperative GDHT was associated with a significant reduction in short-term mortality (risk ratio [RR] 0.75, 95% CI 0.61–0.91, p = 0.004, I 2 = 0), long-term mortality (RR 0.80, 95% CI 0.64–0.99, p = 0.04, I 2 = 4%), and overall complication rates (RR 0.76, 95% CI 0.68–0.85, p < 0.0001, I 2 = 38%). GDHT also facilitated gastrointestinal function recovery, as demonstrated by shortening the time to first flatus by 0.4 days (95% CI −0.72 to −0.08, p = 0.01, I 2 = 74%) and the time to toleration of oral diet by 0.74 days (95% CI −1.44 to −0.03, p < 0.0001, I 2 = 92%).ConclusionsThis systematic review of available evidence suggests that the use of perioperative GDHT may facilitate recovery in patients undergoing major abdominal surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1728-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery—a systematic review and meta-analysis of randomized controlled trials

et al. 2017

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“…One small study (n=66) among patients undergoing radical cystectomy demonstrated a reduced incidence of ileus and of nausea and vomiting at 24 and 48 hours. 236 Restrictive intraoperative fluid may also aid in the reduction of intraoperative blood, when combined with a low-dose continuous norepinephrine infusion. In a study of 166 patients, patients were randomized to receive continuous norepinephrine administration at 2 mcg/kg/hr and 1 mL/kg per hour of Ringer's maleate solution or 6 mL/ kg bolus of Ringer's maleate solution given continuously.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Kassouf

Aprikian

Black

et al. 2016

CUAJ

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This initiative was undertaken in response to concerns regarding the variation in management and in outcomes of patients with bladder cancer throughout centres and geographical areas in Canada. Population-based data have also revealed that real-life survival is lower than expected based on data from clinical trials and/or academic centres. To address these perceived shortcomings and attempt to streamline and unify treatment approaches to bladder cancer in Canada, a multidisciplinary panel of expert clinicians was convened last fall for a two-day working group consensus meeting. The panelists included urologic oncologists, medical oncologists, radiation oncologists, patient representatives, a genitourinary pathologist, and an enterostomal therapy nurse. The following recommendations and summaries of supporting evidence represent the results of the presentations, debates, and discussions. Methodology

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“…What is likewise included in the ERAS protocol, during and after surgery, is that very restrictive fluid management should be introduced. It has been shown that both overhydration and fluid deficiency may impair bowel blood flow, increase rates of cardiopulmonary, wound, and anastomotic complications and in effect prolong POI [61, 62]. However, when compared to colorectal surgery, fluid monitoring in RC patients is more challenging, as urine output can be unreliable.…”

Section: Methodsmentioning

confidence: 99%

How to lower postoperative complications after radical cystectomy - a review

2016

CEJU

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IntroductionLowering morbidity and mortality after RC is subject of considerable interest. Lately, many evidence-based data on improvements in operative technique, anesthetic management, and patient care have been published.In this article, we present a review of literature on how to lower postoperative complications after RC.Material and methodsThe Medline, and Web of Science databases were searched without a time limit on February 2016 using the terms ‘cystectomy’ in conjunction with ‘radical’, ‘bladder cancer’, ‘complications’ or ‘management’. Boolean operators (NOT, AND, OR) were also used in succession to narrow and broaden the search. The search was limited to the English, Polish and Spanish literature.ResultsMany complications may be avoided by appropriate patient selection and meticulous introduction of care protocols.ConclusionsRC as treatment free of complications, even in the hands of an experienced urologist, does not exist. A large number of complications are acceptable in the name of good long-term results. Optimum results are possible with proper surgical technique, good patients and urinary diversion selection and proper patient management in the pre-, peri, and postoperative period.

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A Double-Blind Randomized Controlled Clinical Trial to Assess the Effect of Doppler Optimized Intraoperative Fluid Management on Outcome Following Radical Cystectomy

Abstract: Cardiovascular optimization using esophageal Doppler significantly improved postoperative markers of gastrointestinal function.

Cited by 115 publications

References 24 publications

Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery—a systematic review and meta-analysis of randomized controlled trials

Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery—a systematic review and meta-analysis of randomized controlled trials

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

How to lower postoperative complications after radical cystectomy - a review

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