Haemodynamic Optimization by Oesophageal Doppler and Pulse Power Wave Analysis in Liver Surgery: A Randomised Controlled Trial

Feldheiser, Aarne; Pavlova, Velizara; Weimann, Karin; Hunsicker, Oliver; Stockmann, Martin; Koch, M.; Giebels, Alexander; Wernecke, Klaus‐Dieter; Spies, Claudia

doi:10.1371/journal.pone.0132715

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…This is the commonest device used to perform GDFT in the UK, as well as in widespread use internationally 36 , and is the method suggested by NICE in the UK 8 . Evidence has suggested that transoesophageal Doppler and other methods for GDFT such as lithium dilution techniques 37,38 , calibrated pulse contour analysis 39 and the pleth variability index 40 are not interchangeable; hence the decision was taken to make the study population as homogeneous as possible.…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of goal‐directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery

2019

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BackgroundIntraoperative goal‐directed fluid therapy (GDFT) is recommended in most perioperative guidelines for intraoperative fluid management in patients undergoing elective colorectal surgery. However, the evidence in elective colorectal surgery alone is not well established. The aim of this meta‐analysis was to compare the effects of GDFT with those of conventional fluid therapy on outcomes after elective colorectal surgery.MethodsA meta‐analysis of RCTs examining the role of transoesophageal Doppler‐guided GDFT with conventional fluid therapy in adult patients undergoing elective colorectal surgery was performed in accordance with PRISMA methodology. The primary outcome measure was overall morbidity, and secondary outcome measures were length of hospital stay, time to return of gastrointestinal function, 30‐day mortality, acute kidney injury, and surgical‐site infection and anastomotic leak rates.ResultsA total of 11 studies were included with a total of 1113 patients (556 GDFT, 557 conventional fluid therapy). There was no significant difference in any clinical outcome measure studied between GDFT and conventional fluid therapy, including overall morbidity (risk ratio (RR) 0·90, 95 per cent c.i. 0·75 to 1·08, P = 0·27; I 2 = 47 per cent; 991 patients), 30‐day mortality (RR 0·67, 0·23 to 1·92, P = 0·45; I 2 = 0 per cent; 1039 patients) and length of hospital stay (mean difference 0·01 (95 per cent c.i. −0·92 to 0·94) days, P = 0·98; I 2 = 34 per cent; 1049 patients).ConclusionThis meta‐analysis does not support the perceived benefits of GDFT guided by transoesophageal Doppler monitoring in the setting of elective colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Meta‐analysis of goal‐directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery

2019

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“…12 In addition to standard perioperative monitoring, invasive blood pressure was monitored using the LiDCO plus (LiDCO Ltd, Cambridge, UK). 13 Controlled-goal directed therapy for intravenous fluid administration was applied for the duration of liver resection. 14 After liver resection, goal-directed therapy using fluid challenge and dynamic parameters (stroke volume variation, pulse pressure variation) was applied for patient's volume correction.…”

Section: Methodsmentioning

confidence: 99%

Intravenous iron supplementation after liver surgery: Impact on anemia, iron, and hepcidin levels—a randomized controlled trial

Assouline

Benoliel

Zamberg

et al. 2021

Surgery

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Background: Anemia is a recognized risk factor for perioperative related morbidity and mortality and is frequently reported in liver surgeries with an estimated incidence of 32%. We aim to assess the impact of intravenous iron administration in the immediate postoperative period on anemia and iron status as well as to determine the kinetics of hepcidin after liver surgery. Methods: The HepciFer trial, a randomized controlled trial, included 50 patients undergoing liver surgery. In accordance with the randomization process, patients received either ferric carboxymaltose (15 mg/kg, maximum 1 g) or placebo 4 hours after surgery. Results: The mean hemoglobin level, 7 days after surgery, did not differ significantly between the intervention and control group (11.1 ± 1.8 g/dL and 10.4 ± 1.6 g/dL, respectively) with a mean difference of þ0.7 g/dL ([95% confidence interval, À0.3 to þ1.7], P ¼ .173). Within patients receiving intravenous iron supplementation, none presented biological signs of functional iron deficiency. Hepcidin levels remained significantly higher during the observation period in the intervention group. Inflammatory biomarkers, red blood cells transfusion rate and hospital duration of stay were similar between groups. Conclusion: Intravenous ferric carboxymaltose administration did not result in a significant increase of hemoglobin levels 7 days after surgery. However, this study suggests that intravenous iron supplementation in the immediate postoperative settings prevents functional iron deficiency. Intravenous iron supplementation overcame the hepcidin-mediated blockade of iron absorption and should be considered as the preferred route of administration in the postoperative period.

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“…The concept of GDFT has been applied to various surgical and intensive care scenarios in the last decade [8][9][10][11]. The aim of the previously published HIPHOP I study was to improve perioperative outcomes of patients undergoing hip revision arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Goal-directed fluid therapy using uncalibrated pulse contour analysis and balanced crystalloid solutions during hip revision arthroplasty: a quality implementation project

et al. 2023

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Background To implement a goal-directed fluid therapy (GDFT) protocol using crystalloids in hip revision arthroplasty surgery within a quality management project at a tertiary hospital using a monocentric, prospective observational study. Methods Adult patients scheduled for elective hip revision arthroplasty surgery were screened for inclusion in this prospective study. Intraoperatively stroke volume (SV) was optimized within a previously published protocol using uncalibrated pulse contour analysis and balanced crystalloids. Quality of perioperative GDFT was assessed by protocol adherence, SV increase as well as the rate of perioperative complications. Findings were then compared to two different historical groups of a former trial: one receiving GDFT with colloids (prospective colloid group) and one standard fluid therapy (retrospective control group) throughout surgery. Statistical analysis constitutes exploratory data analyses and results are expressed as median with 25th and 75th percentiles, absolute and relative frequencies, and complication rates are further given with 95% confidence intervals for proportions using the normal approximation without continuity correction. Results Sixty-six patients underwent GDFT using balanced crystalloids and were compared to 130 patients with GDFT using balanced colloids and 130 controls without GDFT fluid resuscitation. There was a comparable increase in SV (crystalloids: 65 (54–74 ml; colloids: 67.5 (60–75.25 ml) and total volume infused (crystalloids: 2575 (2000–4210) ml; colloids: 2435 (1760–3480) ml; and controls: 2210 (1658–3000) ml). Overall perioperative complications rates were similar (42.4% (95%CI 30.3–55.2%) for crystalloids and 49.2% (95%CI 40.4–58.1%) for colloids and lower compared to controls: 66.9% (95%CI 58.1–74.9)). Interestingly, a reduced number of hemorrhagic complications was observed within crystalloids: 30% (95%CI 19.6–42.9); colloids: 43% (95%CI 34.4–52.0); and controls: 62% (95%CI 52.6–69.9). There were no differences in the rate of admission to the post-anesthesia care unit or intensive care unit as well as the length of stay. Conclusions Perioperative fluid management using a GDFT protocol with crystalloids in hip revision arthroplasty surgery was successfully implemented in daily clinical routine. Perioperative complications rates were reduced compared to a previous management without GDFT and comparable when using colloids. Trial registration: ClinicalTrials.gov identifier: NCT01753050.

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Haemodynamic Optimization by Oesophageal Doppler and Pulse Power Wave Analysis in Liver Surgery: A Randomised Controlled Trial

Cited by 5 publications

References 34 publications

Meta‐analysis of goal‐directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery

Meta‐analysis of goal‐directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery

Intravenous iron supplementation after liver surgery: Impact on anemia, iron, and hepcidin levels—a randomized controlled trial

Goal-directed fluid therapy using uncalibrated pulse contour analysis and balanced crystalloid solutions during hip revision arthroplasty: a quality implementation project

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