Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial

Mukai, Akira; Suehiro, Koichi; Watanabe, Ryota; Juri, Takashi; Hayashi, Yasue; Tanaka, Katsuaki; Fujii, Takashi; Ohira, Naoko; Oda, Yutaka; Okutani, Ryu; Nishikawa, Kiyonobu

doi:10.1016/j.bja.2020.08.060

Cited by 46 publications

(56 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No treatment protocol was applied in the control groups, possibly having an influence on their results. The positive effects of standard operation procedures and GDT protocols have been reported in different clinical settings 26‐28 . In our retrospective study, GDT protocols have been performed in both groups according to the clinical standard.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

Grundmann

Wischermann

Faßbender

et al. 2021

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background Intraoperative hypotension is associated with increased morbidity and mortality. The Hypotension Prediction Index (HPI) is an advancement of the arterial waveform analysis to predict intraoperative hypotension minutes before episodes occur enabling preventive treatments. We tested the hypothesis that the HPI combined with a personalized treatment protocol reduces intraoperative hypotension when compared to arterial waveform analysis alone. Methods We conducted a retrospective analysis of 100 adult consecutive patients undergoing moderate‐ or high‐risk noncardiac surgery with invasive arterial pressure monitoring using either index guidance (HPI) or arterial waveform analysis (FloTrac) depending on availability (FloTrac, n = 50; HPI, n = 50). A personalized treatment protocol was applied in both groups. The primary endpoint was the incidence and duration of hypotensive events defined as MAP <65 mmHg evaluated by time‐weighted average of hypotension. Results In the FloTrac group, 42 patients (84%) experienced a hypotension while in the HPI group 26 patients (52%) were hypotensive (p = 0.001). The median (IQR) time‐weighted average of hypotension in the FloTrac group was 0.27 (0.42) mmHg versus 0.10 (0.19) mmHg in the HPI group (p = 0.001). Finally, the median duration of each hypotensive event (IQR) was 2.75 (2.40) min in the FloTrac group compared to 1.00 (2.06) min in the HPI group (p = 0.002). Conclusions The application of the HPI combined with a personalized treatment protocol can reduce incidence and duration of hypotension when compared to arterial waveform analysis alone. This study therefore provides further evidence of the transition from prediction to actual prevention of hypotension using HPI.

show abstract

Section: Discussionmentioning

confidence: 99%

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

Grundmann

Wischermann

Faßbender

et al. 2021

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“… 66 Intra- and postoperative care are also being standardized in ERAS protocols (e.g., fluid therapy, opioid-sparing analgesia). 67 …”

Section: Discussionmentioning

confidence: 99%

“…66 Intra-and postoperative care are also being standardized in ERAS protocols (e.g., fluid therapy, opioid-sparing analgesia). 67 The reduction of postoperative complications is important because complications are associated with reduced overall survival. Additionally, the reduction of complications positively impacts (progression-free) survival.…”

Section: Perioperative Carementioning

confidence: 99%

Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

et al. 2021

View full text Add to dashboard Cite

Objective The aim of this study is to identify preoperative patient-related prognostic factors for anastomotic leakage, mortality, and major complications in patients undergoing oncological esophagectomy. Background Esophagectomy is a high-risk procedure with an incidence of major complications around 25% and short-term mortality around 4%. Methods We systematically searched the Medline and Embase databases for studies investigating the associations between patient-related prognostic factors and anastomotic leakage, major postoperative complications (Clavien–Dindo ≥ IIIa), and/or 30-day/in-hospital mortality after esophagectomy for cancer. Results Thirty-nine eligible studies identifying 37 prognostic factors were included. Cardiac comorbidity was associated with anastomotic leakage, major complications, and mortality. Male sex and diabetes were prognostic factors for anastomotic leakage and major complications. Additionally, American Society of Anesthesiologists (ASA) score > III and renal disease were associated with anastomotic leakage and mortality. Pulmonary comorbidity, vascular comorbidity, hypertension, and adenocarcinoma tumor histology were identified as prognostic factors for anastomotic leakage. Age > 70 years, habitual alcohol usage, and body mass index (BMI) 18.5–25 kg/m2 were associated with increased risk for mortality. Conclusions Various patient-related prognostic factors are associated with anastomotic leakage, major postoperative complications, and postoperative mortality following oncological esophagectomy. This knowledge may define case-mix adjustment models used in benchmarking or auditing and may assist in selection of patients eligible for surgery or tailored perioperative care.

show abstract

“…GDFT is mainly used to guide fluid replacement based on SVV, which is estimated by pulse profile analysis and based on the influence of the respiratory cycle on cardiac pumping function. SVV, as a functional hemodynamic parameter, can indicate the dynamic trend of hemodynamics under cardiac preload [12]. According to a previous study [13], SVV, as an indicator for assessment in fluid therapy, has a high sensitivity and specificity, and can guide fluid therapy in patients receiving OLV.…”

Section: Discussionmentioning

confidence: 99%

Effect of Goal-Directed Fluid Therapy on Lung Function, Cognitive Function and Inflammatory Response in Patients Undergoing Radical Esophageal Cancer Surgery under One-Lung Ventilation

Zhao¹,

Li²,

Xia³

et al. 2021

JCT

View full text Add to dashboard Cite

Objective: To explore the effects of goal-directed fluid therapy (GDFT) on lung function, cognitive function and inflammatory response in patients undergoing radical esophageal cancer surgery under one-lung ventilation. Methods: Sixty-seven patients undergoing radical esophageal cancer surgery were divided into GDFT group (GDFT therapy) and control group (conventional liquid therapy). The changes in patients' pulmonary function, cognitive function and inflammatory response were evaluated. Results: Both alveolar-arterial oxygen partial pressure difference [P(A-a)O 2 ] and respiratory index (RI) increased at one-lung ventilation for 30 minutes (T 2 ) and decreased at one-lung ventilation for 60 minutes (T 3 ), and after surgery (T 4 ) in the two groups, and the GDFT group was lower than the control group (P < 0.05); theoxygenation index (OI) of the two groups decreased at T 2 , T 3 , and T 4 compared with that at T 1 (before one-lung ventilation), and the GDFT group was higher than the control group (P < 0.05). At T 4 and T 5 , the tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), central nervous system specific protein (S100β), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P < 0.05), while interleukin-10 (IL-10) was higher compared to the control group (P < 0.05); the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P < 0.05). Conclusion: GDFT can help prevent lung injury during radical esophageal cancer surgery under one-lung ventilation, reduce the body's inflammatory response,

show abstract

Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial

Cited by 46 publications

References 29 publications

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension

Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

Effect of Goal-Directed Fluid Therapy on Lung Function, Cognitive Function and Inflammatory Response in Patients Undergoing Radical Esophageal Cancer Surgery under One-Lung Ventilation

Contact Info

Product

Resources

About