Goal-directed hemodynamic therapy versus restrictive normovolemic therapy in major open abdominal surgery: A randomized controlled trial

Abstract

Background: The aim of this study was to compare the occurrence of postoperative complications in patients undergoing elective open abdominal surgery and receiving intraoperative goal-directed hemodynamic therapy or restrictive normovolemic therapy. Methods: A total of 401 patients were randomized in the goal-directed hemodynamic therapy or restrictive normovolemic therapy groups. A cardiac output monitor was used in all goal-directed hemodynamic therapy patients and was left at the discretion of anesthetists in charge of patients in the restrictive normovolemic therapy group. The primary outcome was a composite morbidity endpoint (30day mortality and complications grade 2e4 according to Dindo-Clavien classification). Secondary outcomes were the hospital duration of stay, the incidence of pulmonary, cardiovascular, and renal complications up to 30 days after surgery, and midterm survival. Results: Intraoperatively, the goal-directed hemodynamic therapy group received higher intravenous fluid volumes (mean of 10.8 mL/kg/h and standard deviation of 4.0) compared with the restrictive normovolemic therapy group (mean of 7.2 mL/kg/h and standard deviation of 2.0; P < .001). On the first postoperative day, similar fluid volumes were infused in the 2 groups. The primary outcome occurred in 57.7% of goal-directed hemodynamic therapy and 53.0% of restrictive normovolemic therapy (relative risk, 1.09 [95% confidence interval, 0.91e1.30]), and there was no significant difference between groups for any secondary outcomes. Conclusion: Among patients undergoing major open abdominal surgery, the goal-directed hemodynamic therapy and the restrictive normovolemic therapy were associated with similar incidence of moderateto-severe postoperative complications and hospital resource use.

Goal-Directed Intraoperative Fluid Therapy Benefits Patients Undergoing Major Gynecologic Oncology Surgery: A Controlled Before-and-After Study

“…A larger amount of fluid was infused in our group of patients compared with the other types of surgery including laparoscopic gastric bypass surgery ( 7 ), colorectal surgery ( 8 ), and esophageal surgery ( 9 ). Even compared with patients undergoing other open abdominal surgeries (including visceral, vascular, and urology surgeries) receiving goal-directed fluid therapy ( 10 ), patients in our study received more fluids intraoperatively (15.8 vs. 10.8 ml/kg/h). Compared with another study conducted by our research team following a similar methodology in major spine surgeries ( 11 ), intraoperative fluid transfusion was almost twice the amount (15.8 vs. 8.8 ml/kg/h).…”

Myocardial injury after major noncardiac surgery: A secondary analysis of a randomized controlled trial

“…This is a post hoc analysis of a single-center randomized trial on fluid therapy 11 that was approved by the Ethics Committee at the University of Geneva (NAC 09e022) and registered at ClinicalTrials. gov (NCT02625701).…”

“…Therefore, we planned to reanalyze the data from patients who underwent major abdominal surgery and participated in a randomized controlled trial with perioperative measurements of cardiac troponin I (TnI) or high-sensitivity cardiac troponin T (hsTnT). 11 The objectives were to describe the perioperative risk factors for MINS and examine the clinical impact on postoperative outcome.…”

Khảo Sát Thay Đổi Một Số Chỉ Số Huyết Động Trong Mổ Ở Bệnh Nhân Phẫu Thuật Tiêu Hóa Lớn Được Truyền Dịch Theo Đích Dưới Hướng Dẫn Của Escco

“…Việc sử dụng một phương tiện thăm dò huyết động để đưa ra các quyết định can thiệp trong cuộc gây mê, như dùng vận mạch hay bù thêm dịch, có cần thêm trợ tim hay không… đã được nhiều tác giả khẳng định là cần thiết, đặc biệt trong các cuộc mổ lớn, mặc dù còn nhiều tranh cãi về hiệu quả và ảnh hưởng đến tiên lượng của những thăm dò ấy. [2][3][4] Cung lượng tim liên tục ước tính (esCCO -estimated continuous Cardiac Output) là thống đo cung lượng tim thông qua thời gian truyền sóng mạch (PWTT -Pulse Wave Transit time) và các thông số theo dõi chuẩn -điện tim, SpO2, huyết áp động mạch không xâm lấn hay xâm lấn -để ước tính cung lượng tim liên tục và không xâm lấn theo thời gian thực. Đây là phương tiện không cần cảm biến hay quy trình phức tạp, được nhiều nghiên cứu chứng minh tính đúng đắn và đủ độ chuẩn xác để sử dụng trên lâm sàng.…”