Goal directed fluid and hemodynamic therapy with trans-thoracic echocardiographic aortic blood flow peak velocity variation in children and postoperative outcome : A randomized controlled trial protocol

Kumba, Claudine

doi:10.35248/2385-4529.20.7.35

Cited by 26 publications

(41 citation statements)

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“…One third of the patients in this cohort presented intra-operative and or postoperative complications and patients with fatal outcome were all ASA 3 or more. It is time to reconsider the integration of uid and hemodynamic goal directed therapy in these patients with the aim to improve postoperative evolution since these protocols are not yet a routine practice in our Hospital (24,25,26,27,28,29,30,31).…”

Section: Previous Studies Reported Re-operation Rates Between 2 and 5% (38)mentioning

confidence: 99%

Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery

Kumba

2021

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Background and Objective : An observational study conducted earlier to determine predictors of postoperative outcome in non-cardiac surgical pediatric patients showed that factors which influenced postoperative evolution were multiple. These included American Society of Anesthesiologists (ASA) score, transfusion, age, emergency surgery, and surgery. The objective was to describe in details outcomes in non-preterm children under one year old included in the initial study. Methods : Secondary analysis of the initial retrospective observational study in 594 patients with a mean age of 90.86±71.80 months. The Ethics Committee approved the study under the registration number 2017-CK-5-R1. Results : There were 97 non-preterm children included with a mean age of 4.4±3.5 months. Mean weight was 5.1±2.7 kilograms. There were 48 abdominal surgical patients (49.5%), 48 neurosurgical patients (49.5%) and 1 orthopedic surgery patient (1%). 30 patients had intra-operative and or postoperative complications (organ failure or sepsis) (30.9%). The most common intra-operative complication was hemorrhagic shock (5.2%); the most affected system in the postoperative period was the respiratory system in terms of organ failure and pulmonary sepsis with an overall rate of 12.4%; the most common postoperative infection was septicemia (7.2%). The rate of postoperative renal failure was 1%. There were 5 in-hospital deaths (5.2%). Conclusion : In this cohort of 97 non-preterm infants under one year old, the rate of patients with intra-operative and or postoperative complications was 30.9%. It is time to reconsider integrating goal directed therapies in intra-operative patient management to improve postoperative outcome.

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Section: Previous Studies Reported Re-operation Rates Between 2 and 5% (38)mentioning

confidence: 99%

Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery

Kumba

2021

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“…These aims are to optimize oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction in different tissues of the organism. Considering the following equations, one will understand the physiology and the basis of GDT [14,22,23,34,36]. [22,23,[34][35][36].…”

Section: Rationale Of Goal Directed Therapiesmentioning

confidence: 99%

“…Considering the goal directed fluid and hemodynamic therapy (GDFHT) point of view [9][10][11][12][13][14][15][16][17][18][19][20]. The objectives of the GDFHT are to optimize DO 2 to the tissues and tissular VO 2 .…”

Section: Rationale Of Goal Directed Therapiesmentioning

confidence: 99%

“…SV can be assessed echocardiographically with aortic peak velocity variation (ΔVpeak), aortic velocity time integral (VTI) and distance minute (DM) at the aortic valve [9][10][11][12][13][14][15][16][17][18][19][20]. Assessing aortic velocity time integral (VTI) and aortic peak velocity variation (ΔVpeak) will determine fluid responsiveness if fluid therapy with crystalloids and or colloids is necessary or vasopressor-inotropic therapy to increase SV and thus cardiac output [14]. As precised here above the determinants of tissular perfusion are systemic vascular resistance and cardiac output.…”

Section: Rationale Of Goal Directed Therapiesmentioning

confidence: 99%

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Physiology Principles Underlying Goal Directed Therapies in Children

Kumba¹

2020

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“…42(47.7%) patients had intra-operative transfusion.There was 1 in-hospital death (1.1%). Median total length of hospital stay was 9 days [5][6][7][8][9][10][11][12][13][14][15][16].…”

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confidence: 99%

Postoperative Outcome in Children aged between 6 and 10 years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

Kumba¹

2021

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BackgroundAnticipating postoperative evolution in surgical patients is an important issue in our daily practice.We have demonstrated in a previous study that predictors of postoperative outcome are multiple including American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A detailed description of postoperative outcome was undertaken in children aged between 6 and 10 years included in the initial study.ObjectiveTo describe postoperative outcome in children aged between 6 and 10 years included in the initial cohort in abdominal surgery, neurosurgery and orthopedics.MethodsSecondary analysis of postoperative outcome in children aged between 6 and 10 years included retrospectively in the initial study of 594 patients. The study was approved by the Ethics Committee.ResultsThere were 88 patients with a mean age of 98.7±13.8 months.The most common surgical interventions were scoliosis in 23 patients (26.1%), femoral osteotomy 7 patients (7.9%), limb tumor resection 7 patients (7.9%), intracerebral tumor resection 6 patients (6.8%), intestinal resection 5 patients (5.6%), Chiari’s malformation 4 patients (4.5%), pelvic osteotomy 4 patients (4.5%) and renal transplantation 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3) and 13 (14.8%) were ASA grade 4. 22(25%) patients had intra-operative and or postoperative complications (organ dysfunction or sepsis). 2 patients (2.3%) had intra-operative hemorrhagic, 1 patient (1.1%) had an intra-operative difficult intubation and 1 patient experienced intra-operative anaphylaxis. 9 patients (10.2%) had postoperative neurologic failure and 2 (2.3%) postoperative cardio-circulatory failure. 3 patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). Median total length of hospital stay was 9 days [5-16].Conclusion25% of the patients had intra-operative and or postoperative complications and most of them were ASA grade ³3. Integrating goal directed therapies to optimize intra-operative management in these patients is a necessary implementation to improve postoperative outcome in surgical pediatric patients.

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Goal directed fluid and hemodynamic therapy with trans-thoracic echocardiographic aortic blood flow peak velocity variation in children and postoperative outcome : A randomized controlled trial protocol

Abstract: Background: While several parameters of fluid responsiveness have been validated in adults, they cannot be directly applied in children primarily because of the pediatric specificities of the cardiovascular system.

Cited by 26 publications

References 9 publications

Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery

Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery

Physiology Principles Underlying Goal Directed Therapies in Children

Postoperative Outcome in Children aged between 6 and 10 years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

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