Goal-directed fluid therapy in emergency abdominal surgery: a randomised multicentre trial

Aaen, Anne Albers; Voldby, Anders Winther; Storm, Nicolas; Kildsig, Jeppe; Hansen, Estrid Stæhr; Zimmermann-Nielsen, Erik; Jensen, Kasper Løvborg; Tibæk, Pernille; Mortensen, Alan; Møller, Ann Merete; Brandstrup, Birgitte

doi:10.1016/j.bja.2021.06.031

Cited by 37 publications

(26 citation statements)

References 30 publications

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“…Data are represented as median (range). flow-guided fluid therapy did not result in a better outcome compared to a perioperative pressure guided fluid therapy [35]. Question remains therefore whether randomized controlled trials including a heterogeneous patient group are sufficient enough to resolve the issue.…”

Section: Discussionmentioning

confidence: 92%

Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial

Waal

Frank

Scheeren

et al. 2021

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 92%

Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial

Waal

Frank

Scheeren

et al. 2021

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 99%

“…The fluid volumes given on the day of surgery was 3984 vs. 3130 ml respectively. Apart from a longer hospital stay in the flow group, no difference in outcome between the groups was found (Aaen et al, 2021). We divided the patients into two groups, a liberal and a restrictive, after the intravenous fluid volume given; however, the as discussed below, the terms are not well defined in the literature.…”

Section: Discussionmentioning

confidence: 99%

Perioperative fluid administration and complications in emergency gastrointestinal surgery—an observational study

et al. 2022

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Background The fluid balance associated with a better outcome following emergency surgery is unknown. The aim of this study was to explore the association of the perioperative fluid balance and postoperative complications during emergency gastrointestinal surgery. Methods We retrospectively included patients undergoing emergency surgery for gastrointestinal obstruction or perforation. A perioperative fluid balance of 2.5 L divided the cohort in a conservative and liberal group. Outcome was Clavien-Dindo graded complications registered 90 days postoperatively. We used logistic regression adjusted for age, sex, American Society of Anesthesiologists’ classification, use of epidural analgesia, use of vasopressor, type of surgery, intraabdominal pathology, and hospital. Predicted risk of complications was demonstrated on a continuous scale of the fluid balance. Results We included 342 patients operated between July 2014 and July 2015 from three centers. The perioperative fluid balance was 1.6 L IQR [1.0 to 2.0] in the conservative vs. 3.6 L IQR [3.0 to 5.3] in the liberal group. Odds ratio of overall 2.6 (95% CI 1.5 to 4.4), p < 0.001, and cardiopulmonary complications 3.2 (95% CI 1.9 to 5.7), p < 0.001, were increased in the liberal group. A perioperative fluid balance of 0–2 L was associated with minimal risk of cardiopulmonary complications compared to 1.5–3.5 L for renal complications. Conclusion We found a perioperative fluid balance above 2.5 L to be associated with an increased risk of overall and cardiopulmonary complications following emergency surgery for gastrointestinal obstruction or perforation. A perioperative fluid balance of 0–2 L was associated with the lowest risk of cardiopulmonary complications and 1.5–3.5 L for renal complications.

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“…Pcv-aCO2 and Lac at T3, T4 and T5 were superior to the Con group. A study by Aaen et al showed that goal-directed uid therapy close to the maximum SV (GDHT group) did not improve prognosis after surgery for intestinal obstruction or gastrointestinal perforation and may prolong the length of hospital stay [12]. This suggests that the bene ts of GDHT lie not only in providing additional uid when needed, but also in directing and responding to uid use and in avoiding unnecessary uid delivery when achieving haemodynamic goals.…”

Section: Discussionmentioning

confidence: 99%

Effect Of Goal-Directed Haemodynamic Therapy On Short-Term Postoperative Complications In Patients With Extensive Burns: A Single-Centre Randomised Controlled Trial

Li¹,

Cai²,

Cao³

et al. 2022

Preprint

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Background: To investigate the effect of goal-directed hemodynamic treatment on perfusion and short-term prognosis in patients undergoing early Tangential excision and skin grafting for extensive burns.Methods: Ninety-five patients with extensive burns undergoing early Tangential excision and skin grafting were randomly divided into a standard hemodynamic management group (control group) and a goal-directed therapy group (GDHT group), with the control group guided by conventional parameters and the GDHT group guided by stroke volume (SV) based on Vigileo. The primary outcomes were cardiac complications, pulmonary complications, neurological disease, acute kidney injury, and pain within 7 days postoperatively. Secondary outcomes included microcirculatory perfusion metrics: The central venous-arterial carbon dioxide partial pressure difference (Pcv-aCO2), and blood lactate (Lac). investigators assessing outcomes were blinded to group allocation.Results: When analysing 47 subjects in the GDHT group and 48 subjects in the control group, fewer patients in the GDHT group had postoperative pulmonary complications [pneumonia (2:9, P=0.027); oxygenation index <300 (3:8, P=0.041)] and controls were more likely to have atrial fibrillation (4:12, P=0.032) Renal and neurological complications did not differ between groups. Pcv-aCO2 and Lac were higher in the Con group after the intervention compared to the control group, and there was no difference between the two groups postoperatively. In this study, Pcv-aCO2 and Lac were Key influencing factors for pulmonary complications within 7 days postoperatively (Beta=0.197, P=0.000; Beta=0.147, P=0.000).Conclusion: SV-guided GDHT improves microcirculatory perfusion and has fewer short-term postoperative complications compared with standard hemodynamic therapy.Trial registration: NCT05221788 (03/02/2022)

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Goal-directed fluid therapy in emergency abdominal surgery: a randomised multicentre trial

Cited by 37 publications

References 30 publications

Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial

Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial

Perioperative fluid administration and complications in emergency gastrointestinal surgery—an observational study

Effect Of Goal-Directed Haemodynamic Therapy On Short-Term Postoperative Complications In Patients With Extensive Burns: A Single-Centre Randomised Controlled Trial

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